Aggarwal Varun, Nagpal Anjali, Agrawal Yatendra, Kumar Virendra, Kanwal Sandeep Kumar, Dhingra Bhavna
Paediatr Int Child Health. 2014 Feb;34(1):63-5. doi: 10.1179/2046905512Y.0000000029. Epub 2013 Dec 6.
An 11-year-old girl presented with Plasmodium vivax malaria complicated by shock and acute renal failure. The diagnosis of malaria was based on demonstration of trophozoites of P. vivax in the peripheral blood smear and a positive rapid malarial antigen test for P. vivax but negative for P. falciparum. She responded to parenteral artesunate and supportive care. During the course of her infection, she developed pain in her left hypochondrium. Ultrasonography showed multiple hypo-echoic lesions in the spleen and CT scan revealed multiple splenic infarcts. Management was restricted to close clinical monitoring and analgesia. We consider that this is the first report of splenic infarct complicating the course of childhood P. vivax malaria in the English literature. Physicians should suspect and investigate for this rare complication if a patient with malaria complains of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during the course of malaria infection.
一名11岁女孩患间日疟，并发休克和急性肾衰竭。疟疾的诊断基于在外周血涂片上发现间日疟原虫滋养体，以及间日疟快速疟原虫抗原检测呈阳性而恶性疟原虫检测呈阴性。她对静脉注射青蒿琥酯和支持治疗有反应。在感染过程中，她出现左季肋部疼痛。超声检查显示脾脏有多个低回声病变，CT扫描显示多处脾梗死。处理措施仅限于密切临床监测和止痛。我们认为这是英文文献中关于儿童间日疟病程中并发脾梗死的首例报告。如果疟疾患者在感染过程中出现左上腹疼痛、左下胸部胸膜炎性疼痛和/或压痛性脾肿大且脾脏增大，医生应怀疑并调查这种罕见并发症。
