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

Abstract

Malaria is endemic in large parts of India and can cause multiorgan failure and death. Acute pancreatitis as a complication is rare and is potentially fatal. This case series describes five adult patients between 2005 and 2010 who presented with a short duration febrile illness and diagnosed to have malaria with acute pancreatitis. The mean age of the five patients with acute pancreatitis was 40.4 years and four of them were males. None of them were alcohol consumers and did not have any other risk factor for acute pancreatitis. Plasmodium falciparum was responsible for all the cases. Pancreatic enzymes were significantly elevated in all the patients with a mean serum lipase level of 1795 U/L (normal value: <190 U/L) and a mean serum amylase level of 584 U/L (normal value: <100 U/L). Ultrasonography evidence of acute pancreatitis (bulky pancreas) was seen in two patients, and a further two patients had minimal left-sided pleural effusion. Thrombocytopenia (platelet count <100,000/cumm), renal dysfunction (serum creatinine >1.4 mg/dl), and hyperbilirubinemia were seen in all the patients. One patient died due to multiorgan failure. Acute pancreatitis is a very rare complication of malaria, and a high index of suspicion is required in patients presenting with severe malaria and abdominal pain.

Imported Plasmodium vivax malaria complicated by reversible myocarditis

“…The majority of cardiac complications such as pericardial effusion, bundle branch block, cardiomyopathy, and myocarditis have been attributed to P. falciparum infections. [345] Acute myocarditis secondary to P vivax monoinfection is very rare. Very few cases were found after reviewing the literature.…”

“…The pathogenesis of acute myocarditis, although unclear, probably does not differ from that of other organ involvements in malaria and includes mechanical blockage of capillaries resulting from cyto-adherence of infected red blood cells (RBCs) to the vascular endothelium, sequestration of RBCs, and rosetting, in addition to the tumor necrosis factor mediated toxic effects on the myocardium. [48]…”

Late onset acute pancreatitis in P. falciparum malaria – An adverse reaction to intravenous artesunate?

“…Metabolic abnormalities include hypoglycemia, hyponatremia and lactic acidosis. Bacterial infection may coexist in patients presenting with shock or ARDS and this along with a high parasite load has a high mortality [ 4 , 5 ].…”

Successful management of necrotizing pancreatitis in mixed malaria and review of literature

“…Fortunately, the overall deaths have reduced since the launch of the National Malaria Control Program. [ 4 ]…”

“…Only few cases of malaria complicated with acute pancreatitis are summarized in Table 2 . [ 1 3 4 5 6 7 10 ]…”