[Postoperative pernicious malarial attack in a subject, a native of an endemic zone]

The case of an Angolan woman who underwent, in her country, an hysterectomy requiring the transfusion of two whole blood units is reported. In the immediate postoperative period, acute renal failure with anuria set in, justifying the patient's transfer to an intensive care unit in France. Upon admission, she had a thick blood film and serology work-up for Plasmodium falciparum, both of which were negative. On the 20th day, the patient presented a pernicious malarial crisis with a concurrent rise in IgG and IgM titres, indicating recent contamination. The mode of infection is discussed: contaminating anopheline bites associated with the interruption of chemoprophylaxis rigorously followed up till then; post transfusion malaria, almost unavoidable in an endemic country; accidental inoculation by Plasmodium falciparum of the dialysis equipment. Finally, the possibility of pernicious malaria aggravating the initial acute renal failure and hypocalcaemia is also discussed.