Severe falciparum malaria with hypophosphataemia and presumed hypophosphatemia induced rhabdomyolysis: a case report

M Perera,V Samarawickrama,K Lokuketagoda,K Thirumavalawan

doi:10.4038/sljid.v8i2.8225

Abstract

Malaria is eliminated from Sri Lanka, yet cases contracted overseas are still encountered in the country. It is therefore important to be vigilant of possible complications of severe malaria. We report a 31-year-old sailor (Sri Lankan national) with a recent travel history to West Africa who presented with an acute febrile illness of seven days duration. He had high fever, myalgia, drowsiness as well as profuse watery diarrhea. Clinical examination revealed a febrile patient with GCS 15 with no features of meningism. He was icteric with right hypochondrial tenderness. Investigations showed hemolysis. Microscopy and rapid diagnostic assays revealed Plasmodium falciparum infection. He was started on IV artesunate followed by artemisinin based combination therapy orally to which he responded. On day 4 he developed evidence of rhabdomyolysis with low serum phosphate and normal urine phosphate levels. Hypophosphatemia was considered to be the driving factor for rhabdomyolysis, and phosphate replacement was done for which the patient responded and was discharged on day 10 fully recovered.

Highlights

Sri Lanka was certified as having eliminated malaria in 2016 by the WHO.[1]
Severe malaria caused by Plasmodium falciparum is a serious condition with several possible complications
Severe falciparum malaria is associated with a myriad of serious complications such as cerebral malaria, hypoglycemia, acute renal failure and metabolic acidosis

Summary

Introduction

Sri Lanka was certified as having eliminated malaria in 2016 by the WHO.[1]. imported cases of malaria are still seen in the country. On day 4 he developed evidence of rhabdomyolysis with low serum phosphate and normal urine phosphate levels. Hypophosphatemia was considered to be the driving factor for rhabdomyolysis, and phosphate replacement was done for which the patient responded and was discharged on day 10 fully recovered. Severe malaria caused by Plasmodium falciparum is a serious condition with several possible complications.

Results

Conclusion