Case ReportSpontaneous rupture of spleen with complicated falciparum malaria in a United Nations Peacekeeper
Introduction
Globally, malaria is endemic in over 106 countries according to World Health Organization (WHO) World Malaria Report 2011. Despite the availability of sensitive rapid diagnostic tests and a host of antimalarial drugs, it contributed to 655,000 deaths in 2010, of which 91% were in Africa with falciparum malaria as the major contributor. Usually, complications like cerebral malaria, acute renal failure, thrombocytopaenia and abnormal coagulation are seen in falciparum malaria, but spontaneous rupture of spleen is an extremely rare entity with very few published case reports.1, 2 We report one such case encountered in our hospital which had a fatal outcome.
Section snippets
Case report
A 28-year-old Egyptian soldier deployed in United Nations Peacekeeping Mission at Democratic Republic of Congo for past 2 months, was evacuated to our institution with history of high-grade intermittent fever for 04 days followed by disorientation and reduced urine output. He was on chemoprophylaxis with weekly Tab Mefloquine 250 mg since entering the region. On admission, patient was febrile, toxic looking, dehydrated, and was disoriented. Icterus with hepato-splenomegaly was also noted. Rapid
Discussion
The present case presented to us on the sixth day after onset of fever when complications like cerebral malaria, hepatitis and acute renal failure had already set-in. Though the patient showed initial clinical improvement following antimalarial therapy, the unexpected event was the sudden onset of diffuse acute abdominal pain in the absence of any trauma, the aetiology of which could not be ascertained. Splenic rupture with haemoperitoneum was only confirmed during the subsequent emergency
Conclusion
In conclusion, spontaneous splenic rupture in complicated falciparum malaria is extremely rare. High index of clinical suspicion, preoperative diagnosis and rapid intervention are imperative in such a complication because delay in diagnosis may lead to catastrophic consequences.
Conflicts of interest
All authors have none to declare.
Acknowledgements
Lt Col M. Saini, MD (Radiodiagnosis) for providing timely and accurate radiological support which guided the future course of therapy in the case.
Lt Col Sandeep Gupta, MD (Anaesthesia) for providing a high quality critical care during surgery as well as in post-operative period.
Lt Col R.S. Chittoria, MS (Surgery) and Maj Harish H., MS (Surgery) for providing valuable assistance during the surgery.
REFERENCES (10)
- et al.
Spontaneous rupture of malarial spleen presenting as hemoperitoneum: a case report
J Vector Borne Dis
(2010) - et al.
Spontaneous rupture of malarial spleen
Indian Pediatr
(2008) Death from idiopathic rupture of the spleen
BMJ
(1874)- et al.
Spontaneous rupture of spleen in falciparum malaria
Indian J Gastroenterol
(2003) Spontaneous rupture of a malarial spleen
Med J Aust
(1993)
Cited by (3)
Spontaneous spleen rupture with P. ovale malaria
2017, Medecine et Maladies InfectieusesNescient aetiology of splenic laceration – An enigma unveiled
2016, Journal of Clinical and Diagnostic ResearchCase report: spontaneous rupture of spleen in patient with Plasmodium ovale malaria
2016, Wiener Klinische Wochenschrift
Available online 28 September 2012