PD016 - SEVERE MALARIA IN A CHILD COMPLICATED BY SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (ID 1207)
Abstract
Title of Case:
Severe malaria in a child complicated by secondary hemophagocytic lymphohistiocytosis
Background:
Severe malaria is defined as high parasitemia associated with clinical and laboratory signs of organ damage. It is usually caused by Plasmodium falciparum infection and children are more at risk than adults. We report a child with severe malaria infection and secondary hemophagocytic lymphohistiocytosis (HLH) who was successfully treated.
Case Presentation Summary:
A 13-year-old boy from Mali presented to the emergency department with fever for the past 5 days. One week before he had returned to Italy from Mali. On physical examination he was unwell, jaundiced and an enlarged spleen was noted. His blood exams showed slight anemia (Hb 11 g/dl), thrombocytopenia (PLTs 25.000/mcl), hyperbilirubinemia (12 mg/dl), increase in transaminases (GOT 400 U/l, GPT 250 U/l) and C-reactive protein (CRP 180 mg/l). Molecular test for P. falciparum was positive on blood, with a parasitemia of 18%. The patient met the diagnostic criteria for severe malaria and treatment with intravenous artesunate was immediately started. Despite appropriate treatment and reduction of parasitemia to 2%, the patient remained febrile, with worsening anemia and increase of inflammatory markers, including ferritin and triglycerides, therefore secondary HLH was diagnosed. High-dose intravenous corticosteroids were administered, with prompt improvement of the overall clinical state and biochemical markers. Following stabilization, corticosteroids were progressively tapered and antiparasitic therapy was switched to oral artemether and lumefantrine, which was discontinued after one week.
Learning Points/Discussion:
In conclusion, it is important to consider malaria in all febrile patients with history of travel to malarious areas. Severe malaria can be associated with poor outcome. Secondary HLH must be ruled out in children with poor response to anti-malaric treatment, early diagnosis and appropriate treatment can prevent complications and can be life-saving.
