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Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 73-74

Splenic infarction in malaria: An uncommon cause of pain in the abdomen

1 Department of Medicine, College of Medicine and JNM Hospital, Kalyani, India
2 Department of Neuromedicine, Calcutta National Medical College, Kolkata, West Bengal, India
3 Department of Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
4 Department of Medicine, PGIMER and ESIC Hospital ODC (EZ), Kolkata, West Bengal, India

Date of Web Publication21-Jan-2016

Correspondence Address:
Somak Kumar Das
Flat No. A-10, Millennium Apartment, 23, Kalibari Lane, Jadavpur, Kolkata - 700 032, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.174659

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Malaria is one the important endemic diseases in India. The clinical manifestations of malaria are diverse. We report a case of splenic infarction in malaria.

Keywords: India, infarction, malaria, spleen

How to cite this article:
Das SK, Ghosh S, Jana CK, Nath T. Splenic infarction in malaria: An uncommon cause of pain in the abdomen. Muller J Med Sci Res 2016;7:73-4

How to cite this URL:
Das SK, Ghosh S, Jana CK, Nath T. Splenic infarction in malaria: An uncommon cause of pain in the abdomen. Muller J Med Sci Res [serial online] 2016 [cited 2022 Jan 21];7:73-4. Available from: https://www.mjmsr.net/text.asp?2016/7/1/73/174659

  Introduction Top

Malaria is one of the most common infectious diseases throughout India and can manifest with various life-threatening complications of which splenic infarction is rare and only a few cases have been reported in the literature. [1],[2],[3],[4],[5] A case of malaria due to mixed infection with Plasmodium falciparum and Plasmodium vivax who presented with splenic infarction is reported here.

  Case Report Top

A 45-year-old male presented with intermittent fever with chill and rigor, vomiting, and headache for 8 days and pain in the left hypochondrium for 2 days. There was a history of repeated attacks of malaria in the last 2 years. At the time of presentation, his temperature was 104°F, pulse 134 beats/min, and blood pressure (BP) 110/80; he had mild pallor and mild icterus. Abdominal examination revealed hepatomegaly (4-cm enlarged, firm, nontender, and smooth) and splenomegaly (6-cm enlarged, firm, and tender). Investigation revealed hemoglobin of 9 g%, total leukocyte count of 6,000/cu mm, total bilirubin of 4 mg%, serum glutamic oxaloacetic transaminase (SGOT) of 80 IU, serum glutamic-pyruvic transaminase (SGPT) of 75 IU, alkaline phosphatase of 100, serum creatinine of 1 mg%, sickling test to be negative, ring forms of Plasmodium vivax and Plasmodium falciparum in the peripheral blood smear, and normal G6PD activity. Chest x-ray was normal. Ultrasonography (USG) of the whole abdomen revealed hepatomegaly with echogenic parenchyma and splenomegaly (19 cm) with one large hypoechoic lesion. Computed tomography (CT) of the abdomen revealed an area of focal attenuation in the spleen suggesting splenic infarction [Figure 1]. The patient was treated with intravenous (IV) artesunate and oral doxycycline as per guidelines. He was also given nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Subsequently, he was also given primaquine 15 g/day for 2 weeks. He recovered completely from fever and pain over the right hypochondrium also subsided within 1 week. On the 30th day of follow-up, he was asymptomatic and the spleen size was only 2 cm in size and on USG, there was no hypoechoic lesion in the spleen suggesting a complete resolution of the infarction [Figure 2].
Figure 1: CT scan of the abdomen showing splenic infarction (indicated with a broad arrow)

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Figure 2: CT scan of the abdomen after recovery shows a normal spleen

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  Discussion Top

Malaria was confirmed in this case by demonstration of ring forms of Plasmodium vivax and Plasmodium falciparum. Tender splenomegaly with one hypoechoic lesion on abdominal USG and complete clinical recovery with resolution of the infarct size after antimalarial treatment establishes the fact that splenic infarction was due to malaria. About 10 such cases due to both Plasmodium vivax and Plasmodium falciparum have been reported in the literature but only one case due to Plasmodium ovale[6] has been reported, thereby implying that such complications in malaria could be caused due to any species such as Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale. In India, researchers from Rajasthan, a northwest state, reported a series of four acute malaria patients with splenic infarction, two with Plasmodium vivax infection, one with Plasmodium falciparum, and one with a mixed infection (Plasmodium vivax and Plasmodium falciparum). [7] In all these cases, the course was benign and the recovery was uneventful. CT scan of the abdomen is the most sensitive tool for diagnosis of splenic infarction. Splenic infarction can be focal or global and can result due to arterial or venous occlusion. The spleen is supplied by the splenic artery and the short gastric artery. Within the spleen, arterial supply is segmental and occlusion of a secondary branch results in a wedge-shaped infarct. Splenic infarct can occur due to a number of cases such as chronic myeloid leukemia, myelofibrosis, lymphoma, sickle-cell disease, various prothrombotic states, and embolism due to infective endocarditis and atrial fibrillation. Approximately 1/3rd of splenic infarcts is clinically silent and the most common symptom is left hypochondriacal pain, which may be pleuritic and radiate to the left shoulder. The mainstay of therapy is the treatment of the underlying cause.

  Conclusion Top

Splenic infarction, though a rare complication of malaria, should be suspected in any malarial patient developing pain over the left hypochondrium.

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Conflicts of Interest

There are no conflicts of interest.

  References Top

Bonnard P, Guiard-Schmid JB, Develoux M, Rozenbaum W, Pialoux G. Splenic infarction during acute malaria. Trans R Soc Trop Med Hyg 2005;99:82-6.  Back to cited text no. 1
Thabah MM, Kumar M, Ramesh A, Suri Subrahmanyam DK, Elangovan S. A case of vivax malaria with splenic infarction. J Vector Borne Dis 2013;50:74-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Aggarwal V, Nagpal A, Agrawal Y, Kumar V, Kanwal SK, Dhingra B. Plasmodium vivax malaria complicated by splenic infarct. Paediatr Int Child Health 2014;34:63-5.   Back to cited text no. 3
Hwang JH, Lee CS. Malaria-induced splenic infarction. Am J Trop Med Hyg 2014;91:1094-100.   Back to cited text no. 4
Kumar BG, Shetty MA, Chakrapani. Splenic complications in malaria: A case series. Southeast Asian J Trop Med Public Health 2008;39:791-4.   Back to cited text no. 5
Cinquetti G, Banal F, Rondel C, Plancade D, de Saint Roman C, Adriamanantena D, et al. Splenic infarction during Plasmodium ovale acute malaria: First case reported. Malar J 2010;9:288.   Back to cited text no. 6
Gupta BK, Sharma K, Nayak KC, Agrawal TD, Binani A, Purohit VP, et al. A case series of splenic infarction during acute malaria in northwest Rajasthan, India. Trans R Soc Trop Med Hyg 2010;104:81-3.  Back to cited text no. 7


  [Figure 1], [Figure 2]


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