Spontaneous Splenic Laceration in Plasmodium falciparum Malaria: A Case Report

Splenic complications of Plasmodium falciparum malaria are rare but potentially life-threatening. While splenic rupture is more commonly reported, high-grade splenic injury with associated vascular compromise and infarction is less well-described and may present diagnostic and management challenges.

A 32-year-old male presented with a three-day history of high-grade fever, chills, and progressive abdominal symptoms, including acute left upper quadrant pain radiating to the back. On examination, he was febrile with signs of peritonism, including involuntary guarding and rigidity. Laboratory investigations confirmed P. falciparum infection with severe anemia (Hgb 5.1 g/dL). A diagnostic abdominal tap yielded hemorrhagic fluid. Contrast-enhanced computed tomography (CT) demonstrated a high-grade splenic injury (AAST Grade IV) characterized by multifocal splenic infarctions, perisplenic hematoma, and involvement of the splenic hilum. Notably, no active contrast extravasation was identified. Despite this, the patient developed clinical deterioration with worsening hypotension, necessitating emergency splenectomy. Intraoperative findings confirmed a major splenic laceration with 2000 mL of hemolyzed blood in the peritoneum. The patient received intraoperative and postoperative transfusions. The postoperative course was uneventful, and the patient was discharged following appropriate vaccinations and antimalarial therapy.

High-grade splenic injury with infarction should be considered in malaria patients presenting with acute abdominal symptoms. Early recognition and prompt surgical intervention are critical, particularly in patients with clinical deterioration despite non-diagnostic imaging findings for active bleeding.