Hasegawa Chihiro, Inagaki Akiko, Yamada Gohei, Morita Koji, Kitamura Isamu, Ariyoshi Koya
Department of Infectious Disease, Nagoya City East Medical Center, Japan.
Intern Med. 2016;55(22):3393-3398. doi: 10.2169/internalmedicine.55.7069. Epub 2016 Nov 15.
A 58-year-old Japanese man with a high parasitemia of Plasmodium falciparum, returning from Uganda, was admitted to our hospital since his consciousness level rapidly deteriorated after the initial dose of mefloquine. Despite the parasitemia was cleared by quinine by day 7, the coma remained unchanged and diffuse leukoencephalopathy was detected on magnetic resonance image. Steroid pulse therapy was initiated on day 8. Subsequently, the neurological manifestations improved and he was discharged on day 73 without any sequelae. Pathogenesis of P. falciparum causing cerebral malaria is diverse and complex. If neurological symptoms unusually prolong, steroid may be an effective treatment option.
一名58岁的日本男子，恶性疟原虫血症水平较高，从乌干达回国后，因在服用首剂甲氟喹后意识水平迅速恶化而入住我院。尽管在第7天时疟原虫血症已被奎宁清除，但昏迷状态仍未改变，磁共振成像检测到弥漫性白质脑病。在第8天开始使用类固醇脉冲疗法。随后，神经症状有所改善，他在第73天出院，没有任何后遗症。导致脑型疟疾的恶性疟原虫的发病机制多样且复杂。如果神经症状异常延长，类固醇可能是一种有效的治疗选择。
