Febrile urticaria in a family: uncommon manifestation of a common disease

Abstract

Cutaneous manifestations are uncommon with malaria. These include urticaria, purpura fulminans, and petechial rash. We report on a series of three patients from a single family who had an urticarial rash with fever that was subsequently diagnosed to be caused by malaria. Urticarial rash has been previously reported with both falciparum and vivax malaria infections. Although the exact pathogenesis is not clear urticarial rash might be related with IgE mediated mast cell degranulation.

Cutaneous Manifestations of Malaria and Their Prognostic Windows: A Narrative Review

“…A classic presentation of febrile urticaria in the pediatric population is the appearance of wheals associated with edema of underlying subcutaneous tissues. This skin manifestation is believed to result from the malarial subtypes P. falciparum and Plasmodium vivax [ 9 , 10 ]. It is thought that this skin manifestation is antigen-implicated - involving IgE mediation and/or mast cell degranulation processes [ 9 ].…”

“…The resulting increase in the antigenicity of the red blood cells may lead to the degranulation of large stores of mast cells, causing red, itchy wheals [ 9 ]. In these patients, the resulting inflammatory markers released lead to the classic presentation of bronchospasm, shock, and angioedema [ 10 ].…”

“…The patient additionally received a 14-day course of primaquine for radical cure. A second case study by Sharma et al described a family where three members, on separate occasions, presented with urticarial lesions that occurred concomitantly with a fever secondary to P. falciparum infection, suggestive of a potential genetic predisposition nature of febrile urticaria [ 10 ]. It was found that one of the family members, a 15-year-old male, was successfully treated with intravenous artesunate and oral doxycycline, which improved his skin conditions and eventually resulted in a full recovery over two days.…”

Purpura fulminans: an unusual complication of malaria

“…On occasion, it has been reported with malaria or deficiencies of anticoagulants like protein C or S. The management includes treatment of underlying disease and the use of activated protein C. 1 , 2 Cutaneous manifestations are unusual with malaria and purpura fulminans has been reported only occasionally with malaria. 3 , 4…”