Image 21:
This man, 7 days out of Nigeria, presented with a 3 day history of fever and vomiting, He had 4.8% P. falciparum and platelets of 48,000/µl. An ultrasound showed a 13 cm spleen without defects. Vomiting with oral quinine was bothersome but he became afebrile by day 3 of treatment. He returned home and started a home renovation project the next day at which time he began to have severe pleuritic chest pain and left upper quadrant tenderness. This persisted for 5 days at which time he complained and a CT revealed an interesting spleen.
Diagnosis:
He had multiple splenic infarcts with no heart murmur and no other pathology. His symptoms resolved over the next 10 days with the admonition not to do further house renovations for a week. At the time of his admission he had a normal thrombin time, fibrinogen, PTT and PT. At the time of this CT image his PTT was 59.1 (normal < 43.6) and anticardiolipin/MPL 66 (normal <16). Relatively rare anecdotal reports, in the literature from India, have described splenic infarcts in falciparum malaria. The etiology is unclear.
