# Malaria after liver transplantation: Report of two cases and a review of published cases

## TL;DR

This paper reports two cases of malaria in liver transplant recipients and reviews previously documented cases, highlighting the importance of early detection and treatment.

## Contribution

The paper adds two new clinical cases to the global literature on malaria in liver transplant recipients.

## Key findings

- Malaria in liver transplant recipients is rare but has been reported in 17 cases globally.
- Most cases occurred within two months post-transplant, with favorable outcomes when treated promptly.
- Infection may originate from the donor liver or from local exposure in endemic regions.

## Abstract

Malaria is a tropical disease that is rarely reported in liver transplant recipients. However, some cases have been documented around the world and here we report two.

Case 1. A 54-year-old male attended the emergency room 30 days after liver transplantation due to malaise, fever, chills, thrombocytopenia, and anemia. Plasmodium vivax was detected in the blood smear, and the patient was treated with artemether/ lumefantrine, achieving resolution of the parasitemia. Neither chloroquine nor primaquine were prescribed because they were unavailable in the country. Two months later, the patient returned to the emergency room with the same symptoms and was diagnosed with a relapse of malaria caused by P. vivax. The patient received successful treatment with chloroquine and primaquine, which were already available. Given that the liver donor came from a malaria-endemic area, the infection was probably of donor origin, likely by hypnozoites present in the allograft.

Case 2. A 58-year-old woman living in a malaria-endemic region attended the emergency service with fever, malaise, arthralgia, cytopenias, and hypertransaminasemia six months after undergoing a liver transplant. P. vivax was detected in the blood smear, so treatment with chloroquine and primaquine was started. After treatment, the blood smear was negative, and the patient was discharged. In this case, the infection was likely caused by a vector bite in its endemic area of residence or remotely derived from the graft, but it occurred six months after the procedure.

The two cases described here add to the 15 cases of malaria in liver transplant recipients that have been reported in the world. Most of the cases occurred within the first two months after the transplantation, and the outcome was usually favorable, nevertheless, early detection and treatment are essential.