Post Malaria Neurological Syndrome: A rare complication of Malaria
Background: Post malaria neurological syndrome (PMNS) is a rare neurological complication that can occur after recovery from malaria, usually following severe plasmodium falciparum malaria. A total forty three cases have been previously reported in the literature.
Methods: We report a patient with neurological symptoms following one month of clinical and microbiological resolution of severe falciparum malaria following treatment consistent with PMNS.
Results: A 24 year old male presented with fever, confusion, dysarthria and grand mal seizure. His recent medical history was significant for severe falciparum malaria with multi-organ dysfunction including acute kidney injury after being non-compliant with anti-malarial prophylaxis while working for the Peace Corps in Togo prior to falling ill. He fully recovered but still required dialysis, and returned to the United States. He presented to the hospital one month after his initial malaria infection. On physical exam, the patient was febrile to 38.9 C, lethargic and responsive only to painful stimuli. Signs of meningismus were absent. Computed tomography of head, abdomen and thorax were unrevealing. Magnetic resonance imaging of the brain revealed a nonspecific focus of signal abnormality in right internal capsule. Cerebral spinal fluid (CSF) analysis revealed WBC of 75/μL, with lymphocytic pleocytosis and elevated protein of 65 mg/dL. CSF bacterial and viral polymerase chain reaction pane and cryptococcal antigen were negative. CSF VDRL was non-reactive. HIV antigen/antibody serology was negative. Blood, CSF and urine cultures were all negative for growth. Two malaria smears were negative. Initially, he was started on broad spectrum antibiotics, Acyclovir and Coartem which were discontinued following negative lab results, and a steroid taper was initiated. His mental status began improving on the second day of the initiation of the steroid taper, and he fully recovered by day five of steroid therapy.
Conclusion: In patient with recent medical history of malaria who presents with neuropsychiatric symptoms, clinicians must have a high index of suspicion for PMNS.
Fig. 1. MRI of brain showing nonspecific focus of signal abnormality in the posterior limb of the right internal capsule.
A. Laleker, None
P. Poudel, None