Acute renal failure from myoglobinuria secondary to myositis from severe falciparum malaria.
Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.
Sinniah
R
R
Department of Pathology, National University of Singapore, Singapore.
Lye
W
W
D058186:Acute Kidney Injury / Q000209:etiology*; D000293:Adolescent; D001706:Biopsy; D006801:Humans; D007668:Kidney / Q000473:pathology; D016778:Malaria, Falciparum / Q000150:complications* / Q000473:pathology; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D009212:Myoglobinuria / Q000150:complications*; D009220:Myositis / Q000150:complications* / Q000469:parasitology* / Q000473:pathology