Post-malaria neurological syndrome or viral encephalitis?

Area of Science:

• Neurology
• Infectious Diseases
• Tropical Medicine

Background:

• Falciparum malaria is a severe infectious disease requiring prompt treatment.
• Neurological complications can arise even after successful malaria treatment, posing diagnostic challenges.

Observation:

• A 60-year-old man presented with encephalopathy, ataxia, and seizures post-malaria treatment in Angola.
• Cerebrospinal fluid showed lymphocytic pleocytosis and hyperproteinorrhachia, but brain MRI and EEG were normal.
• Extensive testing for neurotropic viruses and infections was negative.

Findings:

• The patient recovered rapidly with antibiotics and antivirals, suggesting post-malaria neurological syndrome.
• The presentation mimicked viral encephalitis, complicating the diagnostic and treatment approach.
• The possibility of false-negative viral PCR in cerebrospinal fluid warrants consideration.

Implications:

• Post-malaria neurological syndrome is a rare but important differential diagnosis in patients with neurological symptoms after malaria.
• The case underscores the complexity of diagnosing neurological syndromes in returned travelers.
• Optimal treatment strategies require careful consideration of differential diagnoses, including infectious and post-infectious neurological conditions.