Hemophagocytic Syndrome in a Four Year Old Male Child with Plasmodium Vivax Infection (original) (raw)
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A case of hemophagocytic syndrome as a complication of <i>Plasmodium</i> vivax malaria
Open Journal of Clinical Diagnostics, 2013
Hemophagocytic lymphohistiocytosis syndrome (HPS) is a potentially fatal hyperinflammatory response characterized by a generalized histiocytic proliferation with marked hemophagocytosis in bone marrow [1]. Hemophagocytic syndrome has been associated with genetic mutations, autoimmune diseases, hematological malignancies or infections [2,3]. According to the data from Centre for Disease Control and prevention (CDC) Plasmodium falciparum has been associated with HPS but not the Plasmodium vivax [4-7]. We report a case of hemophagocytic syndrome as a complication of Plasmodium vivax malaria which is a rare presentation according to the data. This patient presented with high grade fever with chills (P. vivax positive), fever however did not respond to anti-malarials. The patient continued to have high grade fever with altered sensorium and deranged liver function with pancytopenia. Since she fulfilled the criteria of (HPS), patient was put on injectable steroids and responded dramatically. Hemophagocytic syndrome is a potentially fatal syndrome and therefore high index suspicion and early treatment is the key to reduce the mortatlity.
Hemophagocytic syndrome in Plasmodium vivax malaria
Journal of vector borne diseases, 2014
Malaria is one of the most common infectious diseases and a major public health problem. It afflicts >500 million people causing more than one million deaths each year worldwide 1 . The association of pancytopenia in severe malaria due to Plasmodium vivax in children with hemophagocytic syndrome is extremely rare and very few cases are reported in the world literature 2 .
Journal of vector borne diseases, 2013
Hemophagocytic syndrome (HPS) is a reactive disorder of the mononuclear phagocytic system, characterized by benign, generalized histiocytic proliferation, with marked hemophagocytosis in bone marrow 1 . Generally, HPS has been related with hematologic diseases, autoimmune diseases, or with various infections 1 . There are plenty of reports on hemophagocytic syndrome associated with Plasmodium falciparum monoinfetion 2-9 , but reports on the association with P. vivax monoinfection are very scanty 9-14 . In most of these case reports, the diagnosis was made by peripheral blood smear (PBS) and rapid diagnostic test (RDT) without molecular diagnostic confirmation. Thus, there are always chances of species misidentification and missing the mixed infection thereby lacking authenticity. In this case report, the species diagnosis was confirmed by polymerase chain reaction (PCR) and possibilities of other diseases were ruled out by stringent laboratory and biochemical investigations to establish the firm association of hemophagocytic syndrome with P. vivax monoinfection.
Haemophagocytic Syndrome in a 19-Year-Old Male with Plasmodium falciparum Malaria
European Journal of Case Reports in Internal Medicine, 2014
Objectives: Infectious agents triggering haemophagocytic lymphohistiocytosis (HLH) primarily involve the herpes virus group. We report a case of HLH precipitated by Plasmodium falciparum. Materials and methods: Clinical and laboratory findings in a patient presenting with fever were collected. After confirmation of acute malaria, anti-malarial treatment was administered. Results: Despite initial favourable evolution, the patient developed fever again together with a worsening of the haematological parameters and increased ferritin levels. A bone marrow biopsy confirmed the diagnosis of HLH. Conclusion: This case illustrates that HLH should be considered in the differential diagnosis of acute malaria in patients with persisting fever and pancytopenia.
Plasmodium vivax malaria complicated by hemophagocytic syndrome in an immunocompetent serviceman
American Journal of Hematology, 2003
We describe a 23-year-old retired military officer who was immunocompetent but diagnosed with hemophagocytic syndrome (HPS) by Plasmodium vivax infection. Initially, the patient was suspected to have toxic hepatitis related to heavy drinking. But abnormal hematologic findings required a further bone marrow examination and the diagnosis of HPS was made. Antimalarial chemotherapy then brought complete remission. Plasmodium falciparum, a species causing more severe malarial infection, was listed as one of the major causes of HPS. However, P. vivax was not mentioned, and only one case was reported in the literature. In this study, we suggest that P. vivax malaria should be included in the differential diagnosis of HPS, even in an immunocompetent person.
Haemophagocytic lymphohistiocytosis: a cause of unresponsive malaria in a 5-year-old girl
Paediatrics and International Child Health, 2014
A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.
Hematology/Oncology and Stem Cell Therapy, 2016
Malaria-related hemophagocytic lymphohistiocytosis is a rare, potentially fatal, hyperinflammatory disease entity which can be challenging to diagnose and treat. It is usually associated with Plasmodium falciparum infection. It is less frequently associated with Plasmodium vivax. Here we report an unusual case of a 23-year-old healthy Nigerian man who presented with fever, microangiopathic hemolytic anemia, acute renal failure, and confusion, and was diagnosed as having cerebral malaria-related hemophagocytic lymphohistiocytosis caused by P. vivax infection. He was successfully treated with intravenous artesunate and doxycycline with dramatic clinical improvement.
Rare Case of Isolated Plasmodium Vivax Malaria Presenting with Pancytopenia: A Case Report
BJSTR
Pancytopenia is a triad of simultaneous drop in all the three major blood cells including Hemoglobin, White blood cells and Platelets. Etiology of pancytopenia is diverse comprising both hematopoietic and non-hematopoietic disorders including various infections. Malaria is a rare cause of pancytopenia which mostly occur with Plasmodium falciparum and very few cases reported with Plasmodium vivax. This is a case of a 17-year-old girl with no previous co-morbids presented with high grade fever, vomiting, loose motions and decrease appetite for 5 days. On examination she was dehydrated and pale with bruising on arms and thighs. Spleen was palpable. Rest of systemic examination was unremarkable. Complete blood picture showed decreased TLC, Low Hemoglobin and Thrombocytopenia. Liver function tests, Renal function tests, Serum electrolytes, Urine routine examination and Erythrocyte sedimentation rate were normal. C-reactive protein, LDH, Ferritin and D-dimers were raised. Peripheral film showed Retic count of 3%. Dengue serology and Covid-19 PCR was negative. Blood and Urine Cultures showed no growth. Ultrasound abdomen showed splenomegaly. Peripheral smear for Malarial Parasite showed early trophozoites of Plasmodium vivax. Patient was started on Intravenous Artesunate as she could not tolerate Oral antimalarial. Patient became afebrile and blood counts improved after few days and was discharged with follow up test for G6PD assay.
Plasmodium Vivax Malaria with Severe Thrombocytopenia and Varied Skin Manifestations: A Case Report
Plasmodium vivax malaria is an endemic infection in India and is commonly associated with mild haematological abnormalities. Severe thrombocytopenia as well as purpuric skin manifestation are common in isolated falciparum and mixed falciparum/vivax malaria, but is very rare in isolated P.vivax infection. We hereby report a case of severe thrombocytopenia in a case of vivax malaria along with skin lesions presenting as purpura, ecchymosis and urticaria. Vivax malaria can no longer be considered as benign and atypical presentations with severe complications should be borne in the minds of physicians especially in a malaria endemic country like India.