Bonnard Philippe, Guiard-Schmid Jean-Baptiste, Develoux Michel, Rozenbaum Willy, Pialoux Gilles
Service de Maladies Infectieuses et Tropicales, Université Pierre et Marie Curie, Hôpital Tenon (AP-HP), 4 rue de la Chine, 75020 Paris, France.
Trans R Soc Trop Med Hyg. 2005 Jan;99(1):82-6. doi: 10.1016/j.trstmh.2004.06.005.
Malaria is the most frequent cause of fever among travellers returning from tropical countries. Each year about 7000 cases are notified in France, of which 90% are due to Plasmodium falciparum. We describe the case of a Caucasian female patient with no previous exposure to malaria in whom splenic infarction occurred during effective antimalarial treatment for initially uncomplicated acute malaria. Management was restricted to close clinical monitoring and analgesia (subcutaneous morphine). Imaging abnormalities resolved within a few months. We found seven other such cases in the literature. All seven patients were younger and splenic infarction occurred later than in the case we describe. Clinical outcome was favourable in all the cases. It is noteworthy that this rare complication can occur despite appropriate antimalarial prophylaxis and treatment. There are no known predictive signs. Clinicians must be aware that left hypochondrial pain occurring during treatment for acute malaria may be due to splenic infarction.
疟疾是热带国家归国旅行者发热最常见的病因。法国每年报告约7000例病例，其中90%由恶性疟原虫引起。我们描述了一名此前未接触过疟疾的白种女性患者的病例，该患者在最初为单纯性急性疟疾进行有效抗疟治疗期间发生了脾梗死。治疗仅限于密切临床监测和镇痛（皮下注射吗啡）。影像学异常在数月内消退。我们在文献中发现了其他7例此类病例。所有7例患者均较年轻，脾梗死发生时间晚于我们所描述的病例。所有病例的临床结局均良好。值得注意的是，尽管采取了适当的抗疟预防和治疗措施，这种罕见的并发症仍可能发生。目前尚无已知的预测征象。临床医生必须意识到，急性疟疾治疗期间出现的左季肋部疼痛可能是脾梗死所致。
