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Trop Med Health. 2018 Nov 6;46:37. doi: 10.1186/s41182-018-0119-4. eCollection 2018.

Mild encephalitis/encephalopathy with a reversible splenial lesion due to Plasmodium falciparum malaria: a case report.

Author information

1
1Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
2
2Infection Control and Prevention Center, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan.
3
3Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
4
4Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, USA.
5
5General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
6
6Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

Background:

Neurological complications from malaria cause significant morbidity and mortality. Severe cerebral malaria occurs as a result of intense sequestration of infected erythrocytes in the cerebral capillaries. However, the pathology of the reversible neurological symptoms remains unclear. We report the case of a patient with malaria who also had mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) causing transient neurological symptoms.

Case presentation:

A 55-year-old Japanese man was admitted to our hospital with acute fever upon returning from Nigeria. Blood smears and PCR analysis revealed ring forms in the erythrocytes, indicative of Plasmodium falciparum infection. He presented with dysarthria, expressive aphasia, and truncal ataxia, all of which were suggestive of cerebellar ataxia. He had no other signs or symptoms of severe malaria. Artemether/lumefantrine was started on the first day of illness. Although the parasites were undetectable on day 3 of illness, his neurological symptoms persisted. Brain magnetic resonance imaging (MRI) demonstrated a high-signal lesion in the splenium of the corpus callosum on diffusion-weighted images along with a decreased apparent diffusion coefficient. The neurological symptoms gradually improved by day 12. Brain MRI on day 16 showed complete regression of the splenic lesion. Therefore, the patient was diagnosed with MERS due to malaria.

Conclusions:

MERS often causes transient headaches, seizures, and/or impaired consciousness. The symptoms are compatible with the reversible symptoms of cerebral malaria.

KEYWORDS:

Cerebral malaria; Magnetic resonance imaging; Mild encephalitis/encephalopathy with a reversible splenial lesion

Conflict of interest statement

Not applicable.Written informed consent for publication was obtained from the patient.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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