# Splenic accumulation of intact Plasmodium ovale sensu lato-infected red blood cells in a patient presenting with splenic rupture

## TL;DR

A man with Plasmodium ovale malaria suffered a splenic rupture after treatment, with infected red blood cells accumulating in the spleen and blood vessels.

## Contribution

First report of intact Plasmodium ovale-infected erythrocytes accumulating in the spleen and extra-splenic vessels.

## Key findings

- Spleen histology showed a 10-fold accumulation of intact P. ovale-infected erythrocytes in the spleen.
- Infected erythrocytes were found in small extra-splenic blood vessels, suggesting cytoadherence.
- Splenic rupture occurred shortly after starting antimalarial treatment.

## Abstract

A 35-year-old man had splenic rupture just after starting antimalarial treatment with atovaquone-proguanil followed by artesunate for acute Plasmodium ovale sensu lato infection. Spleen histology showed a 10-fold accumulation of intact P. ovale s.l.-infected erythrocytes in the spleen parenchyma compared to the general circulation. Infected erythrocytes also accumulated in small extra-splenic blood vessels, suggesting cytoadherence.

Spontaneous rupture of the spleen is an unusual but severe complication of malaria. Here, we present the case of an otherwise healthy 35-year-old man who presented with splenic rupture hours after starting antimalarial treatment for an acute Plasmodium ovale sensu lato. infection. The spleen is known to be a major site for parasite destruction in malaria, but recent observations have shown that intact P. falciparum- and P. vivax-infected red blood cells accumulate in the spleen. In our reported case, spleen histology showed a 10-fold accumulation of intact P. ovale s.l.-infected erythrocytes in the spleen parenchyma compared to the general circulation, suggesting that intact P. ovale s.l. similarly accumulates in the spleen tissue. We also found infected erythrocytes accumulated in small extra-splenic blood vessels, suggesting cytoadherence. Our case report reinforces the importance of carrying out further studies to better understand ovale malaria pathogenesis and potential clinical complications.