Postoperative Pernicious Malarial Crisis in Patient Coming Back from an Endemic Area

Abstract

The case of a young Moroccan doctor who spent Four months in Congo as part of an international humanitarian military mission; he underwent surgery under spinal anesthesia for an anal fissure a week after being returned to Morocco, In the seventh-day postoperative period, acute renal failure with anuria set in, justifying the patient's transfer to an intensive care unit. Upon admission, on the eighth postoperative day, one day after readmission to the emergency room and was put on triple antibiotic therapy ,and  liquid resuscitation was carried out immediately by infusion of saline isotonic solution and due to the non-improvement of the hemodynamic state after volume repletion, a vasoactive support was rapidly introduced at the initial dose of 0.2 ug / kg / min, the intravenous quinine was not immediately introduced in the emergency room because the initial thick, thin film and malaria blood smear carried out on  admission were negative and the postoperative clinical context argued in favor of bacterial septic shock. A sepsis context not ruled out (blood cultures performed); a surgical revision the morning of his admission to the intensive care by under umbilical laparotomy, didn’t showed an intra-abdominal collection. Parallelly a thick film (30% of parasitized red blood cells) revealing P. falciparum, and blood smear were performed again and came back positive after a positive malaria antigen detection of specific IgMs in the indirect immunofluorescence, confirming the diagnosis. The mode of infection; is associated with the end of chemoprophylaxis rigorously followed up till Finally, the possibility of pernicious malaria aggravating the initial acute renal failure and hipocalcemia is also discussed.