[Spontaneous splenic rupture in acute malaria tropica].
A 44-year-old man developed bouts of fever (up to 40 degrees C) seven days after returning from a holiday in Kenya. Malaria prophylaxis with chloroquine had been correctly undertaken. Concentrations of lactate dehydrogenase and total bilirubin were raised (493 U/l and 3.55 mg/dl, respectively). Blood smear revealed the ring forms of Plasmodium falciparum. Thereupon the patient was given mefloquine in decreasing doses (750/500/250 mg) at intervals of 8 hours. The following night he had a circulatory collapse and complained of pain on pressure, especially in the left upper abdomen. Abdominal sonography showed a slightly enlarged spherical spleen with an echo-poor band and fluid collection in the rectovesicular pouch, indicating rupture of the spleen. A splenectomy was performed. Subsequently the number of malaria organisms in the blood smear gradually fell and signs of haemolysis disappeared. Splenic rupture is a very rare complication of acute malaria. It is presumably caused by marked stasis in the splenic sinuses with deformed parasite-containing red blood cells.
Falk
S
S
Senckenbergisches Zentrum der Pathologie, Universität Frankfurt/Main.
Protz
H
H
Köbrich
U
U
Stutte
H J
HJ
D000208:Acute Disease; D000328:Adult; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D012422:Rupture, Spontaneous; D013154:Spleen / Q000473:pathology; D013161:Splenic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
Spontane Milzruptur bei akuter Malaria tropica.