Spontaneous splenic rupture as a rare complication of Plasmodium vivax: a case report

Spontaneous splenic rupture is a rare but potentially fatal condition. We report the case of a thirty-year-old Moroccan soldier who presented with fever six months after returning from a deployment in a malaria-endemic country, despite appropriate mefloquine chemoprophylaxis. Malaria due to Plasmodium vivax was confirmed by blood film, and oral treatment (Artemether-Lumefantrine) was initiated. Within twenty-four hours of admission, the patient developed acute abdominal pain with hemodynamic instability and a decrease in haemoglobin level. Abdominal computed tomography revealed a subcapsular splenic haematoma with moderate haemoperitoneum, consistent with spontaneous splenic rupture. A decision of conservative management was established with bed rest, close haemodynamic monitoring, intravenous rehydration solution and blood transfusion as necessary, without splenectomy. The outcome was favourable, characterised by defervescence, complete resolution of abdominal pain and no further decrease of haemoglobin. This case illustrates that splenic rupture should be considered in malaria patients with abdominal pain associated with clinical features of hypovolaemia and no history of trauma. It also shows that conservative management can preserve splenic function and lead to a good clinical outcome.