Severe Plasmodium falciparum malaria may be complicated by disseminated intravascular coagulation (DIC) with heterogeneous clinical manifestations. We report the case of a 61-year-old man with recent travel to Angola who presented with severe Plasmodium falciparum malaria complicated by DIC with a predominant thrombotic phenotype. On admission, he exhibited profound thrombocytopenia, markedly elevated D-dimer levels, metabolic acidosis, shock, and evidence of multiorgan dysfunction. Peripheral blood smear demonstrated parasitemia exceeding 25%. Despite prompt initiation of intravenous artesunate, anticoagulation, and comprehensive organ support in the intensive care unit, the patient developed progressive peripheral ischemia requiring right above-knee amputation. Although parasitemia rapidly declined and initial haemodynamic stabilisation was achieved, his hospital course was further complicated by nosocomial infections, and he ultimately died. This case illustrates an underrecognised thrombotic-predominant presentation of malaria-associated DIC, and highlights the diagnostic and therapeutic challenges associated with severe imported malaria in the intensive care setting.
Gisca et al. (Sun,) studied this question.