Severe falciparum malaria simulating fulminant hepatic failure.
OBJECTIVE
To identify clinical and laboratory features of patients with malarial hepatitis simulating fulminant hepatic failure (MHsFHF) and distinguish it from viral FHF.


METHODS
At a tertiary care unit in Bangalore, India, we compared clinical and laboratory characteristics of 25 patients with MHsFHF with those of 25 patients with viral FHF from November 1996 to January 2000.


RESULTS
No statistically significant differences were seen in duration of jaundice, altered consciousness, and the interval between onset of jaundice and altered consciousness between the 2 groups. Hepatomegaly and splenomegaly were present in 72% and 48% of patients with MHsFHF and in 12% and 0% of patients with viral FHF (P<.001), respectively. The MHsFHF group had a significantly lower hemoglobin level (9.3 g/dL vs 12.9 g/dL), total leukocyte count (9.1 x 10(9)/L vs 18 x 10(9)/L), platelet count (44.8 x 10(9)/L vs 218.6 x 10(9)/L), and transaminases (alanine aminotransferase, 86.2 U/L vs 1230.0 U/L; aspartate aminotransferase, 131.9 U/L vs 720.0 U/L) (P<.001). Thrombocytopenia and elevated serum urea nitrogen were universal in patients with MHsFHF. Prothrombin time was abnormal in all patients with viral FHF and in only 1 patient with MHsFHF. Of patients with MHsFHF, 24% died; of patients with viral FHF, 76% died (P=.02).


CONCLUSIONS
In endemic areas, severe malaria should be considered in the differential diagnosis of FHF. Hepatomegaly and normal prothrombin time in the setting of FHF are suggestive of malaria, and a peripheral blood smear should be obtained for diagnostic confirmation.
Devarbhavi
Harshad
H
Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India. d_harshad@vsnl.net
Alvares
Jose Filipe
JF
Kumar
K Shiva
KS
D000293:Adolescent; D000328:Adult; D001806:Blood Urea Nitrogen; D003937:Diagnosis, Differential; D006529:Hepatomegaly; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000821:virology; D016778:Malaria, Falciparum / Q000175:diagnosis*; D008875:Middle Aged