# A Case of Plasmodium vivax-Induced Stress Cardiomyopathy Managed With Extracorporeal Membrane Oxygenation

## TL;DR

A young man with Plasmodium vivax malaria developed severe lung and heart failure, which was successfully treated with ECMO and antimalarial drugs.

## Contribution

This case highlights the use of VAV ECMO for managing stress cardiomyopathy in severe P. vivax malaria.

## Key findings

- The patient developed ARDS and stress cardiomyopathy from P. vivax infection.
- VAV ECMO provided necessary hemodynamic support when standard therapies failed.
- The patient recovered and was discharged after seven days on ECMO.

## Abstract

Acute respiratory distress syndrome (ARDS) and cardiomyopathy can occur as severe manifestations of malarial infections. We present a case of a 20-year-old male who, after recently returning from Nigeria, presented to our hospital with flu-like symptoms and was ultimately diagnosed with Plasmodium vivax infection. He developed severe ARDS and failed conservative management with lung-protective ventilation, steroids, and inhaled pulmonary vasodilators. Given the severity of his disease, he was placed on venovenous extracorporeal membrane oxygenation (ECMO) to provide further pulmonary support. He subsequently developed acute stress cardiomyopathy with severe biventricular failure that did not respond to high-dose vasopressor and inotropic therapy. His cannula configuration was adjusted to veno-arterial-venous (VAV) ECMO to provide additional hemodynamic support. During this time, the patient had been receiving treatment with artesunate. After a total of seven days on ECMO, he was successfully decannulated and safely discharged home with oral antimalarial treatment.