Pyogenic Splenic Abscess With Concurrent Active Plasmodium falciparum Malaria and Sickle Cell Trait: A Case Report

Splenic abscess is a rare but life-threatening condition with poorly understood links to malaria and hemoglobinopathies. We present the case of a young male from West Africa who developed a pyogenic splenic abscess with concurrent Plasmodium falciparum malaria and sickle cell trait. Clinical data were collected through retrospective chart review, and a literature review was conducted focusing on splenic abscess in the context of malaria and hemoglobinopathies. The patient presented with abdominal pain and fever after initiating antimalarial treatment. Imaging revealed a large splenic abscess. Percutaneous drainage yielded purulent fluid, and cultures identified Fusobacterium species. Laboratory findings confirmed sickle cell trait and active malaria. Treatment included antimalarial therapy and broad-spectrum antibiotics with anaerobic coverage. The patient recovered completely after drainage and antimicrobial therapy. This case highlights the importance of considering anaerobic bacterial pathogens, particularly Fusobacterium species, in splenic abscesses among patients from malaria-endemic regions. The concurrent presentation of bacterial infection, active malaria, and sickle cell trait represents a rare scenario demonstrating complex interplay between parasitic infection, hemoglobinopathies, and bacterial superinfection. Healthcare providers should maintain high suspicion for bacterial splenic infections in travelers with splenic complications, even when malaria is diagnosed.