Malaria-Associated Spontaneous Splenic Rupture With Coagulopathy and Hemodynamic Compromise: A Case Report

Spontaneous splenic rupture is a rare, life-threatening condition that occurs without trauma, often presenting diagnostic challenges due to nonspecific symptoms. The risk of spontaneous splenic rupture increases significantly with underlying pathological conditions, including Plasmodium vivax malaria, where rapid splenic enlargement and altered red blood cell surface characteristics likely contribute to the increased risk of rupture. Here, we describe the case of a 23-year-old male patient who presented with severe abdominal pain and hypotension. Examination revealed jaundice, left upper abdominal tenderness, and hypotension. Laboratory findings showed thrombocytopenia and coagulopathy, while CT imaging revealed hemoperitoneum and splenic rupture. P. vivax malaria was confirmed, and the patient recovered fully with clinical monitoring and conservative management, including blood transfusions, antibiotics, and antimalarials, without the need for surgery. Splenic rupture in P. vivax malaria is believed to result from rapid splenic hyperplasia and vascular congestion. The role of early imaging, particularly CT, is crucial in confirming the diagnosis. Conservative management in stable patients appears effective, avoiding the risks associated with splenectomy. In conclusion, spontaneous splenic rupture, though rare, requires high clinical suspicion in P. vivax malaria-endemic regions. It should be considered in patients with sudden abdominal pain and instability, even in the absence of trauma. Further research into its pathophysiology and risk factors is essential for earlier diagnosis and improved management.