Gatot Soebroto Army Central Hospital, Jakarta, Indonesia.
J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211043712. doi: 10.1177/23247096211043712.
Patients chronically infected with hepatitis B virus (HBV) may travel to areas with high endemicity of malaria. The overlap between malaria and HBV infection can be clinically severe and present a diagnostic challenge as both diseases manifest similar symptoms. This case describes a fatal case of a 43-year-old man with chronic HBV infected with malaria that presents as acute kidney injury (AKI) and jaundice following a trip to malaria-endemic region. Despite administering antimalarial and 6 courses of renal replacement therapy, the patient's clinical condition did not improve, leading to septic shock, multi-organ dysfunction, and eventually, death. AKI and jaundice are commonly seen in severe malaria, as well as acute exacerbation of chronic HBV. This case emphasizes the importance to consider malarial screening when evaluating sick returning travelers, even in those with underlying chronic HBV. Given the severity of coinfection, prompt identification of this overlap can avert the rapid deterioration of severe malaria by early administration of intravenous artesunate and renal replacement therapy.
慢性乙型肝炎病毒 (HBV) 感染者可能会前往疟疾高发地区旅行。疟疾和 HBV 感染的重叠可能会在临床上很严重，并带来诊断挑战，因为这两种疾病表现出相似的症状。本病例描述了一名 43 岁慢性 HBV 感染合并疟疾的致命病例，该患者在前往疟疾流行地区后出现急性肾损伤 (AKI) 和黄疸。尽管给予了抗疟药物和 6 次肾脏替代治疗，但患者的临床状况并未改善，导致感染性休克、多器官功能障碍，最终死亡。AKI 和黄疸在严重疟疾以及慢性 HBV 的急性加重中很常见。本病例强调了在评估患病返回旅行者时，即使是那些有潜在慢性 HBV 的旅行者，也要考虑进行疟疾筛查的重要性。鉴于合并感染的严重程度，早期静脉注射青蒿琥酯和肾脏替代治疗可以及早识别这种重叠，从而避免严重疟疾的迅速恶化。
