Postmalaria neurological syndrome: a case of acute disseminated encephalomyelitis?

0833 Post-malaria neurological syndrome: a case report

“…The pathogenesis of postmalaria neurological syndrome, occurring in the absence of parasitemia, appears to be due to the presence of cytokines (tumor necrosis factor-a, interleukin-2, and interleukin-6) produced during the episode of malaria, which remain even after efficacious treatment 1,8 . Studies based on postmalaria cerebellar ataxia have evidenced elevations of these cytokines in both serum and cerebrospinal fluid, as well as a favorable clinical response to corticosteroids, suggesting an immune mechanism as the cause of the syndrome 8 .…”

“…Its overall incidence is 0.1% in patients with malaria due to P. falciparum 1,4 . JCSC, 24 years old, married, a member of the Brazilian military, was admitted on August 15, 2010 at the Emergency Unit of the Army Central Hospital (Hospital Central do Exército, HCE) in Rio de Janeiro, six days after returning from a peacekeeping mission in Haiti that had lasted six months.…”

“…Postmalaria neurological syndrome occurs 300 times more frequently in severe malaria than in non-complicated cases of malaria 1,4 . Its overall incidence is 0.1% in patients with malaria due to P. falciparum 1,4 .…”

“…The postmalaria neurological syndrome was first described by Nguyen and colleagues in 1996, when the criteria for its diagnosis were defined [1][2][3][4][5][6][7][8][9] . The syndrome features an acute onset of neuropsychiatric or neurological symptoms in patients recently treated for malaria due to Plasmodium falciparum and who have no parasitemia when the symptoms appear [1][2] .…”

“…The syndrome features an acute onset of neuropsychiatric or neurological symptoms in patients recently treated for malaria due to Plasmodium falciparum and who have no parasitemia when the symptoms appear [1][2] . The signs and symptoms (and frequency by which they occur) are decreased level of consciousness (77%); confusion (66%); fever (50%); generalized seizures (33%); aphasia (28%); tremor (23%); psychosis (17%); myoclonus (11%); headache and ataxia (each at 8%); and weakness, catatonia, and acalculia (each at 6%) 3 .…”