Plasmodium vivax malaria complicated by splenic infarct

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.