Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: Case report and review of literature

Abstract

Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a two-day history of altered conscious state. A diagnosis of severe falciparum malaria was made based on the clinical presentation and a positive blood smear with parasitaemia of 45%. Despite adequate anti-malarial therapy with artesunate, the patient had persistent and worsening abdominal pain. Investigations suggested a diagnosis of acute pancreatitis, a rare association with falciparum malaria. However, in spite of supportive therapy for acute pancreatitis and a 10-day course of intravenous artesunate and oral doxycycline at recommended doses, he continued to be febrile with peripheral blood smear showing persistence of ring forms. Antimalarial therapy was, therefore, changed to quinine on the suspicion of possible artesunate resistance. On the 17 th day of stay in hospital, the patient developed generalized tonic-clonic seizures. Computerized tomography of the brain showed bilateral fronto-parietal subdural haematomas that were surgically drained. His fever persisted beyond 30-days despite broad-spectrum antibiotics, quinine therapy and negative malarial smears. A possibility of drug fever was considered and all drugs were ceased. He subsequently became afebrile and was discharged on the 38 th hospital admission day. Recognition of complications and appropriate management at each stage facilitated successful outcome. This report has been presented to highlight the occurrence of several rare complications of falciparum malaria in the same patient.

Acute pancreatitis due to malaria: A case report of five patients and review of literature

“…and Mohapatra and Gupta have reported pancreatitis with very high parasitic indices. [ 4 5 6 ] Hyperparasitemia though a predictor for severe malaria is not the only marker for severity. In patients not previously exposed to malaria poor immunity may result in severe disease even with parasitic index as low as 2%.…”

Malarial pancreatitis: Case report and systematic review of the literature

“…[ 7 ] A systematic review of the PubMed and EmBase databases using the search string (“malaria” or “falciparum” or “vivax” or “malariae” or “ovale”) and “pancreatitis” yielded 18 reports (22 cases) on pancreatitis caused by malaria [ Table 2 ]. [ 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ] The most common species responsible was P. falciparum (17/22), which was also the causative species in the index case. Abdominal pain was reported in all cases while icterus was seen in 12 cases.…”

Acute pancreatitis, ascites, and acute renal failure in Plasmodium vivax malaria infection, a rare complication

“…Plasmodium falciparum is one parasite which has been associated with the development of pancreatitis. [ 7 8 ] The cause of it has been the capability of the organism to cause cytoadherence and sequestration leading to capillary thrombosis and pancreatitis, a phenomenon which is well defined. [ 9 10 ]…”