Hyper-reactive malarial splenomegaly and splenic infarct in a caucasian toddler
1Children's Haematology and Cancer Centre, Mount Elizabeth Hospital, Singapore.
Insights
A pediatric traveler developed severe illness due to Plasmodium falciparum malaria, presenting with hyper-reactive malarial splenomegaly. Prompt treatment with atovaquone-proguanil led to recovery, highlighting a rare but serious complication in children.
Area of Science:
- Tropical Medicine
- Pediatric Infectious Diseases
- Parasitology
Background:
- Malaria remains a significant global health concern, particularly in tropical regions.
- Partially treated Plasmodium infections can lead to severe complications, even in pediatric travelers.
- Hyper-reactive malarial splenomegaly (HMS) is a rare but serious condition typically seen in adult residents of endemic areas.
Purpose of the Study:
- To report a case of hyper-reactive malarial splenomegaly in a pediatric traveler returning from Indonesia.
- To highlight the diagnostic and therapeutic challenges associated with severe malaria in children.
- To increase awareness among clinicians regarding potential severe malaria complications in returning pediatric travelers.
Main Methods:
- Case report of a 4-year-old boy with prolonged fever, anemia, and abdominal distension after travel to Indonesia.
- Diagnostic workup included blood smears for malaria parasites and computed tomography (CT) scan.
- Treatment involved antimalarial medication (atovaquone-proguanil) and supportive care.
Main Results:
- Initial diagnosis of Plasmodium vivax malaria treated with chloroquine was ineffective.
- Subsequent detection of Plasmodium falciparum with low parasitemia, massive hepatosplenomegaly, and splenic infarct.
- Treatment with atovaquone-proguanil led to clinical stabilization, reduced spleen size, and parasite clearance.
Conclusions:
- Hyper-reactive malarial splenomegaly can occur in pediatric travelers, presenting a diagnostic challenge.
- Partially treated malaria, even with P. vivax initially, can mask or lead to severe P. falciparum complications.
- Clinicians must maintain a high index of suspicion for severe malaria in children returning from tropical regions.
Abstract:
A 4-year-old boy from the United States had been staying in Indonesia for five months when he presented with fever, severe lethargy, progressive weight loss, and abdominal distension. He was first diagnosed with Plasmodium vivax infection in Indonesia and received treatment with chloroquine. However, his condition continued to deteriorate and he required erythrocyte transfusion for severe anemia. Three weeks into his illness, he was found to have low parasitemia with Plasmodium falciparum with massive hepatosplenomegaly in Singapore. A splenic infarct was also documented on computed tomography. Treatment with atovaquone-proguanil resulted in stabilization of the hemoglobin level and rapid reduction in splenic size, with clearance of malarial parasites from the bloodstream. Although reported typically in adult tropical residents, hyper-reactive malarial splenomegaly may occasionally be found in the pediatric traveler. Clinicians receiving children returning from the tropical regions should be aware of this potentially life-threatening complication of partially treated malaria.
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