Hyper-Reactive Malarial Splenomegaly and Splenic Infarct in a Caucasian Toddler

Abstract

A 4-year-old boy from the United States had been staying in Indonesia for five months when he presented with fever, severe lethargy, progressive weight loss, and abdominal distension. He was first diagnosed with Plasmodium vivax infection in Indonesia and received treatment with chloroquine. However, his condition continued to deteriorate and he required erythrocyte transfusion for severe anemia. Three weeks into his illness, he was found to have low parasitemia with Plasmodium falciparum with massive hepatosplenomegaly in Singapore. A splenic infarct was also documented on computed tomography. Treatment with atovaquoneproguanil resulted in stabilization of the hemoglobin level and rapid reduction in splenic size, with clearance of malarial parasites from the bloodstream. Although reported typically in adult tropical residents, hyper-reactive malarial splenomegaly may occasionally be found in the pediatric traveler. Clinicians receiving children returning from the tropical regions should be aware of this potentially lifethreatening complication of partially treated malaria.

Haematologist-reviewed peripheral blood smear in paediatric practice

“…It can also be diagnostic in malarial and other protozoal infections, although these were not investigated in this series of patients. (8) The PBS can also reveal characteristic signs that may aid in the diagnosis of the Epstein-Barr virus, cytomegalovirus, and Bordetella pertussis infections. (9) In children presenting with unexplained neurodevelopmental delay, the finding of lymphocyte vacuolation may suggest an underlying metabolic disease.…”