Hyper-reactive malarial splenomegaly: Rare cause of pyrexia of unknown origin

Abstract

Hyper-reactive malarial splenomegaly (HMS) or Tropical splenomegaly syndrome(TSS), occurs in areas of high transmission of malaria. These children usually presents with gross splenomegaly and abdominal discomfort, while fever is not the usual manifestation in majority of them. It is a disease of young adults and rarely reported below 8 years of age. Here it is reported a three-year-old child who presented as pyrexia of unknown origin with hepatosplenomegaly, diagnosed as HMS.

Tropical Splenomegaly Syndrome in a pregnant woman: A good response and prognosis to splenectomy

“…Weakness, dyspnea, and functional murmur reflect the degree of anemia. All these findings were manifested by the woman 7,9 . The exact assessment for TSS (HMS) is difficult and the condition should be differentiated from other causes of splenomegaly in the tropics-Kala-Azar, schistosomiasis, post-necrotic cirrhosis, thalassemia, leukemia, lymphoma, myelofibrosis, non-tropical idiopathic splenomegaly, Felty's syndrome 2 .…”

“…Chloroquine and Proguanil appear to be equally effective. But Chloroquine and Proguanil are not recommended during pregnancy 7 . Quinine is the antimalaria drug of choice for pregnant women.…”

“…Malarial parasites are not found in the peripheral blood. There is increase in the serum levels of polyclonal IgM with cryoglobulinemia, reduced C3 and the rheumatoid factor may be positive 2,7 . Medical management with antimalarial drugs for prolonged period of time is the gold standard therapy for tropical splenomegaly syndrome.…”

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

“…8 Differentiation from chronic lymphoproliferative disorders is important in the adult patient, but this is usually not an issue in childhood, though the condition has rarely been reported in pediatric ages. 9,10 However, diagnostic confusion may happen as HMS may be mistaken as other febrile illnesses in the young child, 9 or when the child presents late after returning from an endemic area. 10 Splenic infarct is an unusual complication from malarial infection, but it is often innocuous and no treatment is required.…”

Splénomégalie palustre hyper-réactive

“…Hors zone impaludée, d'après plusieurs publications, il semble qu'un traitement antipalustre standard [65] (non prolongé et adapté au profil de résistance) permettrait d'obtenir une évolution clinique favorable [16,35,66,67]. Dans l'étude de Van den Ende et al [16], 49 patients présentant une SPH ont reç u un traitement antipalustre de durée courte avec une évolution favorable (des récidives sont survenues après réexposition [44]).…”