Abstract
Introduction: The hypercoagulable complications of malaria
typically manifest in the microvasculature. However, there are several
cases of intracranial venous thrombosis caused by Plasmodium falciparum
and Plasmodium vivax malaria and there was one case report of pulmonary
thromboembolism due to Plasmodium falciparum. To the best of our
knowledge, there have not been case reports of plasmodium vivax
associated with pulmonary thromboembolism.
Case Presentation: A 30-year-old Ethiopian male patient
presented with sudden onset shortness of breath of 3 days duration. He
had also high grade fever, chills and rigors associated with loss of
appetite and fatigue of similar duration. He was from malaria endemic
area. He had a pulse rate of 108 beats per minutes, respiratory rate of
32 breaths per minute, oxygen saturation of 82% with atmospheric air
and temperature of 38.9 degree Celsius. Further examination revealed
accentuation of pulmonary component of second heart sound. Complete
blood count revealed mild anemia and peripheral blood film showed
trophozoites of Plasmodium vivax. Pulmonary CT angiography showed
filling defects on the right and left pulmonary arteries. The patient
was diagnosed to have plasmodium vivax malaria complicated with
pulmonary thromboembolism. He was managed with intranasal oxygen,
antimalarial agent and anticoagulation. Upon serial evaluations on the
3rd week and 2nd month of follow up,
he did not have complaints and physical examination was non-remarkable.
Conclusion: Malaria is a protozoan disease with high mortality
and morbidity. For a long time, severe cases of malaria were thought to
be mostly caused by Plasmodium falciparum. However, recent evidences
have shown a paradigm shift and we should remember that Plasmodium vivax
can also cause severe malaria and this can be complicated by
hypercoagulable conditions.
Key words : Malaria, Pulmonary thromboembolism, Plasmodium vivax