Pathological Rupture of the Spleen in a Patient with Severe Falciparum Malaria

Abstract

Pathological rupture of the spleen is a recognized but rare complication of malarial infection. This is a case report of a 59-year-old male patient with a pathological rupture of the spleen caused by Plasmodium falciparum infection. The patient first became febrile at 40°C 7 days after returning from Kenya. He was admitted to ourhospital with dysfunction of the renal, liver, and coagulation systems. Examination of a peripheral blood smear and DNA analysis of the blood sample using alle-specific PCR demonstrated a severe malarial parasitemia with P. falciparum alone. He was treated immediately with quinine, which completely removed the parasites by the 3rd day of admission. Nevertheless, repeated ultrasonography revealed a rapidly enlarging spleen, and he suddenly fell into hemorrhagic shock due to rupture of the spleen on the 4th hospital day. The spleen with a tear was removed because of uncontrolled bleeding. Histopathological examination revealed features of atrophy of the lymphoid follicles, dilated sinusoidal space, and prominent erythrophagocytosis. He recovered from severe malaria and was discharged without any disability. It is important to anticipate that malaria can be a primary cause of pathological rupture of the spleen, and we should also pay attention to rapid hyperplasia of the spleen, even after parasitemia has disappeared.