Falciparum Malaria-Induced Splenic Infarction

On the final day of a 3-day oral artemether-lumefantrine combined malaria treatment, a 30-year-old man in the infectious diseases ward began experiencing pain in the left hypochondriac region. A peripheral smear examination revealed the presence of banana-shaped Plasmodium falciparum gametocytes within erythrocytes (Figure 1). Additionally, a rapid diagnostic immunoassay confirmed the presence of P. falciparum antigen in the patient’s blood. Abdominal ultrasonography identified a patchy hypoechoic lesion in the spleen (Figure 2), which was later confirmed as an infarct area through venous phase contrast-enhanced abdominal computed tomography (Figure 3). Observations also included splenomegaly, with a vertical length of 146 mm, and an increased splenic vein diameter of 11 mm. These findings were attributed to a splenic infarction caused by malaria. Malaria can lead to various splenic complications, including splenic infarction, spontaneous splenic rupture, hyperreactive malarial syndrome, hypersplenism, ectopic spleen and splenic torsion, and splenic cysts¹. Splenic infarction, although not commonly observed, is likely underdiagnosed in many instances of complicated malaria^2,3. Despite its rarity, splenic infarction should be considered as a potential complication in patients experiencing left quadrant pain during malaria treatment.

FIGURE 1:
Appearance of banana-shaped Plasmodium falciparum gametocytes in erythrocytes on peripheral smear (black arrows).

FIGURE 2:
Ultrasonography showing a patchy hypoechoic area in the spleen (white arrows).

FIGURE 3:
Venous phase contrast-enhanced computed tomography showing the infarct area in the spleen (red arrows).

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Hwang J-H and Lee C-S. Malaria-Induced Splenic Infarction. Am J Trop Med Hyg. 2014;91(6):1094-100. Available from: https://doi.org/10.4269/ajtmh.14-0190
  » https://doi.org/10.4269/ajtmh.14-0190
• ²
  Lu Y, Zhang S, Jiang C. Splenic infarction during acute falciparum malaria: A case report. Front Med (Lausanne). 2022;9:951812. Available from: https://doi.org/10.3389/fmed.2022.951812
  » https://doi.org/10.3389/fmed.2022.951812
• ³
  Kim SH, Jung HS and Park S. Serial follow-up of malaria-induced splenic infarction: A case report. Ann Hepatobiliary Pancreat Surg. 2020;24(2):239-42. Available from: https://doi.org/10.14701/ahbps.2020.24.2.239
  » https://doi.org/10.14701/ahbps.2020.24.2.239

• Financial Support: No funding was received for this study.

Publication Dates

• Publication in this collection
  22 Sept 2023
• Date of issue
  2023

History

• Received
  09 July 2023
• Accepted
  03 Aug 2023