Spontaneous splenic rupture in Plasmodium vivax malaria: first case reported in Colombia

Abstract

A case of pathological splenic rupture associated with malaria complicated by Plasmodium vivax is presented in a 28-year-old male patient from El Retorno, Guaviare. The patient presented with fever, left-sided chest pain, vomiting, diarrhea, tachycardia, tachypnea, and signs of hemodynamic hypotension associated with hypovolemic shock. Upon admission, he was treated with analgesics (500 mg dipyrone, 100 mg tramadol) and intravenous fluids. The hemogram revealed neutrophilia and thrombocytopenia, while the thick smear was positive for P. vivax with 24,000 parasites/μl. During his brief 4-hour hospital stay, the patient experienced progressive deterioration of his general condition, culminating in a cardiopulmonary arrest that did not respond to resuscitation efforts, resulting in his death. Histopathological examination showed aggregates of polymorphonuclear neutrophils and plasmacytosis. The patient did not receive parenteral antimalarial treatment. Splenic rupture associated with malaria is a severe and potentially fatal complication. Therefore, any painful splenomegaly in an acute malaria episode should be considered a warning sign of potential splenic rupture. It is crucial to enhance the awareness of local medical teams regarding this complication, promoting timely diagnosis and treatment to improve clinical outcomes.