Spontaneous Pathologic Splenic Rupture in a Patient with Plasmodium falciparum Infection, First Case Reported in Israel.

Yves Weinberg,Arie Feldman,Joseph Mishal,Daniel J Jakobson

doi:10.3390/idr12030022

Abstract

Travelers exposed to malaria may develop severe disease and complications. A less well-known complication is spontaneous pathologic splenic rupture, which is still under-reported and has never been reported in Israel. In this paper, we report a 23 years old healthy young man presenting in the emergency department, two weeks after coming back from Sierra Leone, with intermittent fever, mild tachycardia and mild left upper quadrant abdominal pain. The patient was diagnosed with Plasmodium falciparum infection and developed rapidly after hospital admission spleen rupture. He was managed conservatively at first but ultimately underwent splenectomy after being hemodynamically unstable. In the recovery period, the patient developed acute respiratory distress syndrome and was reintubated. A high level of suspicion is recommended in every malaria patient presenting with left upper quadrant abdominal pain, even if minimal. Ultrasonography availability in the internal medicine department may be a critical diagnostic tool, especially in non-endemic areas.

Highlights

Malaria is a mosquito-borne infection affecting humans
The disease is transmitted by a single cell microorganism from the Plasmodium group, Plasmodium falciparum (P. falciparum) having the largest burden followed by Plasmodium vivax
We report a patient with Plasmodium falciparum infection who developed within a few hours spontaneous splenic rupture

Summary

Introduction

Malaria is a mosquito-borne infection affecting humans. The disease is transmitted by a single cell microorganism from the Plasmodium group, Plasmodium falciparum (P. falciparum) having the largest burden followed by Plasmodium vivax Endemic area populations are at lower risks for severe disease, except for young children, pregnant women and immunocompromised patients (including a-splenic patients). Less well known, life-threatening complication of malaria is spontaneous pathologic splenic rupture [7]. This complication is rare but probably under-reported. We report a patient with Plasmodium falciparum infection who developed within a few hours spontaneous splenic rupture. He was managed at first with conservative management but required emergent splenectomy due to hemodynamic deterioration

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