Rare Association of Plasmodium Vivax Malaria with Pulmonary Thromboembolism: A Case Report

Abstract

Introduction:The hypercoagulable complications of malaria typically manifest in the microvasculature. However, there are several cases of intracranial venous thrombosis caused by Plasmodium falciparum and Plasmodium vivax malaria and there was one case report of pulmonary thromboembolism due to Plasmodium falciparum. To the best of our knowledge, there have not been case reports of plasmodium vivax associated with pulmonary thromboembolism.Case Presentation: A 30-year-old Ethiopian male patient presented with sudden onset shortness of breath of 3 days duration. He had also high grade fever, chills and rigors associated with loss of appetite and fatigue of similar duration. He was from malaria endemic area. He had a pulse rate of 108 beats per minutes, respiratory rate of 32 breaths per minute, oxygen saturation of 82% with atmospheric air and temperature of 38.9 degree Celsius. Further examination revealed accentuation of pulmonary component of second heart sound. Complete blood count revealed mild anemia and peripheral blood film showed trophozoites of Plasmodium vivax. Pulmonary CT angiography showed filling defects on the right and left pulmonary arteries. The patient was diagnosed to have plasmodium vivax malaria complicated with pulmonary thromboembolism. He was managed with intranasal oxygen, antimalarial agent and anticoagulation. Upon serial evaluations on the 3 rd week and 2 nd month of follow up, he did not have complaints and physical examination was non-remarkable. Conclusion:Malaria is a protozoan disease with high mortality and morbidity. For a long time, severe cases of malaria were thought to be mostly caused by Plasmodium falciparum. However, recent evidences have shown a paradigm shift and we should remember that Plasmodium vivax can also cause severe malaria and this can be complicated by hypercoagulable conditions.

Plasmodium Falciparum Malaria and Concomitant High-Risk Pulmonary Thromboembolism: Case Report

“…Two cases were described in the literature, one of massive venous thromboembolism due to plasmodium falciparum infection associated with disseminated intravascular coagulation, in which the patient had a poor outcome, the second pulmonary thromboembolism due to plasmodium vivax attributed to hypercoagulable changes in malaria, with favorable evolution of the patient [7,8]. In our case, we believe that plasmodium falciparum infection was the basis for the activation of the coagulation cascade, resulting in high-risk PTE (presence of hemodynamic instability), without evidence of DIC in a patient without identified risk factors for hypercoagulability [9,10].…”

“…There are five species that cause disease in humans, namely plasmodium falciparum, plasmodium vivax, plasmodium ovale, plasmodium malariae and plasmodium knowlesi [7]. Severe malaria is usually caused by plasmodium falciparum, however, severe malaria and even deaths can occur in patients infected with plasmodium vivax [3,10]. Severe manifestations described include changes in consciousness, generalized convulsions, metabolic acidosis, liver dysfunction, hypoglycemia, renal dysfunction, respiratory distress, disseminated intravascular coagulation, severe anemia, shock and death [8].…”