title: Post-malaria neurological syndrome or viral encephalitis?
abstract: We present a case of a 60-year-old Caucasian man recently returned from Angola, where he had been successfully treated for a severe (non-cerebral) falciparum malaria infection. He was presented to the emergency room, with a subacute onset encephalopathy, ataxia and a generalised tonic-clonic seizure. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis (123 cells/µL) and hyperproteinorrhachia (188 mg/dL). Brain MRI and EEG were unremarkable. CSF PCR testing for neurotropic viruses was negative as were CSF and blood cultures. The patient was treated with ceftriaxone and acyclovir, with full recovery on the second day of treatment. We believe post-malaria neurological syndrome, a rare self-limited encephalopathy, should be considered in the differential diagnosis. Nevertheless, the presentation, lack of changes on brain MRI and EEG, along with possible false-negative CSF viral PCR, could still represent a viral encephalitis, which brings to question the treatment approach to adopt (conservative vs wide spectrum antiviral plus antibiotics).
authors.affiliation: Neurology Department, Hospital Egas Moniz-Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Caetano
authors.affiliation: Neurology Department, Hospital Egas Moniz-Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Marcelo D
authors.initials: MD
authors.lastname: Mendonça
authors.affiliation: Department of Internal Medicine, Hospital São Francisco Xavier, CHLO, Lisbon, Portugal.
authors.forename: Nuno Ribeiro
authors.initials: NR
authors.lastname: Ferreira
authors.affiliation: Neurology Department, Hospital Egas Moniz-Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Alves
mesh_terms: D002524:Cerebellar Ataxia / Q000209:etiology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D018792:Encephalitis, Viral / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D016779:Malaria, Cerebral / Q000175:diagnosis*; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology