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Falciparum malaria or fulminant hepatic failure?
T Ahsan1, S M Rab, M S Shekhani
1Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi.
JPMA. the Journal of the Pakistan Medical Association
|October 1, 1993
Summary
Severe falciparum malaria can mimic fulminant hepatic failure, presenting with jaundice and encephalopathy. Suspect this rare condition in patients with persistent fever and specific liver function test results.
Area of Science:
- Hepatology
- Infectious Diseases
- Tropical Medicine
Background:
- Falciparum malaria can present with severe hepatic involvement.
- Fulminant hepatic failure (FHF) is a critical diagnosis with high mortality.
- Distinguishing malaria-induced hepatitis from other causes of FHF is crucial for timely treatment.
Purpose of the Study:
- To report six cases of severe jaundice and encephalopathy caused by falciparum malaria.
- To highlight a rare presentation of falciparum malaria mimicking FHF.
- To guide clinicians in suspecting and diagnosing this condition.
Main Methods:
- Retrospective case series analysis of six patients.
- Clinical presentation review, including fever, jaundice, encephalopathy, and hepatomegaly.
- Liver function tests (LFTs) analysis, focusing on bilirubin and enzyme levels.
- Liver biopsy findings in diagnosing falciparum hepatitis.
Main Results:
- Six patients presented with severe jaundice and encephalopathy, initially diagnosed as FHF.
- Key indicators for suspecting falciparum malaria included persistent fever, jaundice, encephalopathy, and hepatomegaly.
- Liver function tests showed predominantly conjugated hyperbilirubinemia with only modest elevations in liver enzymes and alkaline phosphatase.
- Liver biopsy confirmed falciparum malaria as the cause in all cases.
Conclusions:
- Falciparum hepatitis is a rare but severe manifestation of falciparum malaria.
- Clinical suspicion is key, especially in endemic areas, when patients present with fever, jaundice, encephalopathy, and hepatomegaly.
- Characteristic LFT patterns and liver biopsy are vital for accurate diagnosis and appropriate management.