Case Report: Sudden Splenic Rupture in a Plasmodium falciparum-Infected Patient

Spontaneous splenic rupture: A rare complication of concurrent malaria and dengue infections - A case report

INTRODUCTION

Spontaneous splenic rupture (SSR) is a rare, life-threatening complication, sometimes associated with infections like malaria and dengue fever. This case report details a unique presentation of SSR.

CASE PRESENTATION

A 28-year-old male in Somalia presented with fever, epigastric pain, nausea, vomiting, and body aches, consistent with malaria and dengue. Following self-discharge after initial malaria treatment, his condition deteriorated rapidly, leading to severe abdominal pain and hypotension. Laboratory tests confirmed malaria and dengue, with low hemoglobin. A CT scan revealed a large hemoperitoneum and splenic rupture requiring emergency laparotomy and splenectomy. Post-operative recovery was uneventful.

DISCUSSION

This case highlights the diagnostic challenges posed by overlapping symptoms of malaria and dengue, potentially masking SSR. The concurrent infections likely contributed to splenomegaly, increasing rupture risk. While SSR has been linked to malaria or dengue individually, this case suggests a potential synergistic effect of co-infection. The patient's self-discharge emphasizes the importance of patient education and treatment adherence. Successful surgical intervention underscores the critical role of prompt medical care.

CONCLUSION

This is the first reported case of SSR secondary to concurrent Plasmodium falciparum malaria and dengue fever in Somalia. This highlights the need for improved diagnostic tools, healthcare infrastructure, and targeted public health interventions in endemic regions. Further research is crucial to understand the synergistic effect of these co-infections in inducing SSR.

Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.

A novel antiplasmodial compound: integration of in silico and in vitro assays

Malaria is a disease caused by Plasmodium genus. which P. falciparum is responsible for the most severe form of the disease, cerebral malaria. In 2018, 405,000 people died of malaria. Antimalarial drugs have serious adverse effects and limited efficacy due to multidrug-resistant strains. One way to overcome these limitations is the use of computational approaches for prioritizing candidates to phenotypic assays and/or in vitro assays against validated targets. Plasmodium falciparum Enoyl-ACP reductase (PfENR) is noteworthy because it catalyzes the rate-limiting step of the biosynthetic pathway of fatty acid. Thus, the study aimed to identify potential PfENR inhibitors by ligand (2D molecular similarity and pharmacophore models) and structure-based virtual screening (molecular docking). 2D similarity-based virtual screening using Tanimoto Index (> 0.45) selected 29,236 molecules from natural products subset available in ZINC database (n = 181,603). Next, 10 pharmacophore models for PfENR inhibitors were generated and evaluated based on the internal statistical parameters from GALAHAD™ and ROC/AUC curve. These parameters selected a suitable pharmacophore model with one hydrophobic center and two hydrogen bond acceptors. The alignment of the filtered molecules on best pharmacophore model resulted in the selection of 10,977 molecules. These molecules were directed to the docking-based virtual screening by AutoDock Vina 1.1.2 program. These strategies selected one compound to phenotypic assays against parasite. ZINC630259 showed EC₅₀ = 0.12 ± 0.018 µM in antiplasmodial assays and selective index similar to other antimalarial drugs. Finally, MM/PBSA method showed stability of molecule within PfENR binding site (ΔG_binding=-57.337 kJ/mol).Communicated by Ramaswamy H. Sarma.