title: [Hyper-reactive malarial splenomegaly].
abstract: Hyper-reactive malarial splenomegaly is a rare and severe form of chronic malaria. This condition is a common cause of splenomegaly in endemic areas. The pathophysiology of hyper-reactive malarial splenomegaly involves an intense immune reaction (predominantly B cell-driven) to repeated/chronic infections with Plasmodium sp. The diagnosis may be difficult, due to a poorly specific clinical presentation (splenomegaly, fatigue, cytopenias), a long delay between residence in a malaria-endemic area and onset of symptoms, and a frequent absence of parasites on conventional thin and thick blood smears. A strongly contributive laboratory parameter is the presence of high levels of total immunoglobulin M. When the diagnostic of hyper-reactive malarial splenomegaly is considered, search for anti-Plasmodium antibodies and Plasmodium nucleic acids (genus and species) by PCR is useful. Diagnosis of hyper-reactive malarial splenomegaly relies on the simultaneous presence of epidemiological, clinical, biological and follow-up findings. Regression of both splenomegaly and hypersplenism following antimalarial therapy allows the differential diagnosis with splenic lymphoma, a common complication of hyper-reactive malarial splenomegaly. Although rare in Western countries, hyper-reactive malarial splenomegaly deserves increased medical awareness to reduce the incidence of incorrect diagnosis, to prevent progression to splenic lymphoma and to avoid splenectomy.
authors.affiliation: Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Maazoun
authors.affiliation: Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Deschamps
authors.affiliation: Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Barros-Kogel
authors.affiliation: Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Ngwem
authors.affiliation: Service de microbiologie, centre hospitalier intercommunal de Créteil, 94010 Créteil, France.
authors.forename: N
authors.initials: N
authors.lastname: Fauchet
authors.affiliation: Service de parasitologie, CHU Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Laboratoire d'excellence GR-Ex, 75015 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Buffet
authors.affiliation: Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France. Electronic address: antoine.froissart@chicreteil.fr.
authors.forename: A
authors.initials: A
authors.lastname: Froissart
mesh_terms: D000906:Antibodies / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000235:genetics / Q000276:immunology; D013163:Splenomegaly / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*
chemical_list: D000906:Antibodies; D000962:Antimalarials; D007075:Immunoglobulin M
keywords: Hyper-reactive malarial splenomegaly; Malaria; Paludisme; Plasmodium falciparum; Splénomégalie palustre hyper-réactive