Splenic infarction in a paediatric patient with Plasmodium vivax malaria from Ethiopia: a case report

Abstract

BACKGROUND: Splenic infarction is an uncommon but serious side effect of Plasmodium vivax malaria, especially in young patients. Prompt diagnosis and effective treatment are essential to avoid serious consequences. Though there are few report of splenic infarction following P. vivax from different endemic country, PubMed and Google-based literature search found that it was the first case report of this type from Ethiopia. CASE PRESENTATION: The patient was an 11-year-old girl, from Wolaita Sodo, Ethiopia, who had a high-grade fever, chills, rigors, headache, vomiting, and abdominal pain in the left upper quadrant. Upon examination, hepatomegaly, splenomegaly, and extreme pallor were found. Laboratory tests revealed acute kidney injury (creatinine 1.63 mg/dL), acute liver injury (AST 323 U/L, ALT 129 U/L), and severe anaemia (haemoglobin 3.4 g/dL, haematocrit 10.2%). A peripheral blood smear showed a trophozoite stage of P. vivax and was negative for Plasmodium falciparum. An abdominal ultrasound revealed hepatosplenomegaly along with a wedge-shaped, multifocal, hypoechoic splenic region that was consistent with an infarction. MANAGEMENT AND OUTCOME: The patient had blood transfusions, NSAIDs for pain, and intravenous artesunate as treatment. Primaquine was used in radical therapy. After three days, her abdominal pain had considerably subsided and she became afebrile. Complete symptom relief, normalized abdominal ultrasound findings, and better laboratory results-including normal haemoglobin and liver enzymes-were all observed at the two-month follow-up. CONCLUSION: This case underscores the importance of considering splenic infarction in paediatric patients with P. vivax malaria presenting with abdominal pain. Early recognition through imaging and laboratory investigations, along with prompt antimalarial therapy, is critical for favourable outcomes.