title: [Splenomegaly in an Eritrean refugee: the hyper-reactive malaria splenomegaly syndrome.]
abstract: Hyper-reactive malaria splenomegaly (HMS) is a rare and potentially severe complication of malaria. It is likely that the incidence of patients with HMS will rise in the Netherlands due to the recent increase in asylum-seekers from Sub-Saharan Africa. It can be difficult to diagnose this disease, as this case shows.
  
  
  
  A 31-year-old male from Eritrea was admitted with fever and dyspnea, caused by an influenza A-infection. The patient also presented with cachexia, pronounced hepatosplenomegaly and pancytopenia. Microscopic diagnostic analysis for malaria was negative. HMS was eventually diagnosed through high-sensitivity qPCR for malaria, which showed the presence of a very low level of Plasmodium falciparum parasitemia; furthermore, IgM levels were high and malaria serology was strongly positive.
  
  
  
  HMS should be considered in patients from malaria-endemic areas presenting with splenomegaly and pancytopenia. Because standard diagnostics for malaria are often negative in this population, malaria serology and sensitive qPCR play an important diagnostic role.
authors.affiliation: Radboudumc, Nijmegen.
authors.forename: M M
authors.initials: MM
authors.lastname: Cruijsen
authors.forename: I J
authors.initials: IJ
authors.lastname: Reuling
authors.forename: M
authors.initials: M
authors.lastname: Keuter
authors.forename: R W
authors.initials: RW
authors.lastname: Sauerwein
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Ven
authors.forename: Q
authors.initials: Q
authors.lastname: de Mast
mesh_terms: D000328:Adult; D019017:Eritrea; D006529:Hepatomegaly; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D009426:Netherlands; D012036:Refugees; D013163:Splenomegaly / Q000175:diagnosis* / Q000188:drug therapy* / Q000469:parasitology; D013577:Syndrome