title: Refractory pancytopenia and megaloblastic anemia due to falciparum malaria.
abstract: Anemia is a common complication in malarial infection. Direct destruction and ineffective erythropoesis does not adequately explain the cause of anemia in malaria. We present a case with refractory megaloblastic anemia with asymptomatic falciparum malaria. We hypothesize that promoter variants in the inducible nitric oxide synthase gene might be the cause of severe refractory megaloblastic anemia and pancytopenia in our patient. Malaria should always be kept in mind as a cause of anemia especially in endemic areas even if the child is asymptomatic or there is no demonstrable parasite on routine smear examination.
authors.affiliation: Department of Pediatrics, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi, India. dranugulati@gmail.com
authors.forename: Varun
authors.initials: V
authors.lastname: Aggarwal
authors.forename: Anu
authors.initials: A
authors.lastname: Maheshwari
authors.forename: Bimbadhar
authors.initials: B
authors.lastname: Rath
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.forename: Srikanta
authors.initials: S
authors.lastname: Basu
mesh_terms: D000749:Anemia, Megaloblastic / Q000175:diagnosis / Q000235:genetics / Q000469:parasitology* / Q000628:therapy; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D002648:Child; D004359:Drug Therapy, Combination; D017707:Erythrocyte Transfusion; D017809:Fatal Outcome; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D052247:Nitric Oxide Synthase Type II / Q000235:genetics; D010198:Pancytopenia / Q000175:diagnosis / Q000235:genetics / Q000469:parasitology* / Q000628:therapy; D010963:Plasmodium falciparum / Q000302:isolation & purification; D017713:Platelet Transfusion; D014805:Vitamin B 12 / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D014803:Vitamin B Complex; D000077332:Artesunate; D005492:Folic Acid; D052247:Nitric Oxide Synthase Type II; D014805:Vitamin B 12