Acute Kidney Failure Confused with Thrombocytopenic Thrombocytic Purpura in Malaria: A Case Report

Abstract

Malaria has become widespread, especially in sub-Saharan Africa, owing to disruptions experienced during the Covid-19 pandemic. Both cerebral malaria and acute kidney injury are important indicators of severe malaria. Depending on the degree of acute renal failure, hemodialysis/hemofiltration treatment is required. Our patient was a 22-year-old male from the Republic of Chad. The patient with confusion came to our country 15 days prior and was admitted to the internal medicine intensive care unit. Initially, Thrombocytopenic Thrombocytic Purpura (TTP) was considered because of clinical and laboratory similarities. As the patient had a history of coming from an endemic area, anemia, thrombocytopenia, and splenomegaly, malaria was considered. The patient was diagnosed with falciparum malaria due to the presence of multiple ring-shaped trophozoites and banana gametocytes. The patient with cerebral malaria, hyperparasitemia (parasite load 15%), hyperbilirubinemia and acute kidney injury was considered to have severe malaria. Intravenous artesunate was planned, but since it could not be obtained immediately, oral artemether+lumefantrine was started, and the patient became conscious at the 24th hour of treatment. During the follow-up, the patient's creatinine levels increased to 6.9, and the patient was subjected to hemodialysis several times. After effective hemodialysis and antimalarial treatment, the patient was discharged without sequelae on the 20th day of hospitalization. This case report is thought to be important in that it emphasizes that the diagnosis of malaria may be delayed due to its confusion with microangiopathic hemolytic anemias, and that it emphasizes the importance of correct management of complications.