SHM Converge Scientific Abstract ePoster Gallery-The Gift That Keeps on Giving: A Case of Severe Falciparum Malaria and on-Going Hemolytic Anemia After Resolution of Parasitemia

The Gift That Keeps on Giving: A Case of Severe Falciparum Malaria and on-Going Hemolytic Anemia After Resolution of Parasitemia

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This case describes a 32-year-old man who returned from a 2-week trip to Africa without malaria prophylaxis and initially presented with vomiting, non-bloody diarrhea, chills, and fatigue. He was first diagnosed with E. coli gastroenteritis and discharged, but returned four days later with persistent fever, body aches, diarrhea, and jaundice. On exam, he was tachycardic, tachypneic, hypotensive, and in severe distress with anasarca. Labs showed anemia, thrombocytopenia, renal failure, and severe lactic acidosis, and a blood smear revealed Plasmodium falciparum.<br /><br />Because of the severity of illness, he was treated with artesunate and supportive care. He improved clinically, and parasitemia resolved. However, after discharge, he returned five days later with dark urine and worsening anemia. Repeat smear showed no parasites, but hemoglobin had dropped further and LDH and bilirubin were markedly elevated, suggesting ongoing hemolysis despite clearance of the infection.<br /><br />The authors discuss that severe falciparum malaria can cause life-threatening hemolytic anemia and multi-organ failure. They also highlight the possibility of post-artesunate delayed hemolysis (PADH), a known complication in which hemolysis occurs after treatment and after parasitemia has cleared. In this case, the patient’s initial GI symptoms led to diagnostic uncertainty, and antibiotics were stopped when hemolysis raised concern for hemolytic uremic syndrome.<br /><br />The report emphasizes that falciparum malaria can rapidly become fatal, but artesunate is life-saving in severe cases. It also stresses the need for continued monitoring for delayed hemolysis after treatment, since anemia can worsen even after the organism is eradicated.

Asset Subtitle

Insiya Attarwala

Meta Tag

Author List Insiya Attarwala, Stephen Hosea

Category Clinical Vignettes

Concept Severe Falciparum Malaria

Concept Peripheral Blood Smear

Concept Parasitemia

Concept Post-Artesunate Delayed Hemolysis

Concept Shock

Distinguished Non-Finalist

Presenter Organization Santa Barbara Cottage Hospital

Presenting Author Insiya Attarwala

Track Adult

Keywords

Plasmodium falciparum

severe malaria

artesunate

post-artesunate delayed hemolysis

PADH

hemolytic anemia

renal failure

jaundice

Africa travel

multi-organ failure

Severe Falciparum Malaria

Peripheral Blood Smear

Parasitemia

Post-Artesunate Delayed Hemolysis

Shock