Disseminated Intravascular Coagulation With a Predominant Thrombotic Phenotype in Severe Plasmodium falciparum Malaria: A Case Report

TL;DR

A man with severe malaria developed a rare blood clotting disorder that led to serious complications and death despite treatment.

Contribution

Highlights a rare thrombotic-predominant DIC case in severe imported malaria.

Findings

Patient presented with severe P. falciparum malaria and thrombotic-predominant DIC.

Despite treatment, the patient developed peripheral ischemia and died from complications.

Case emphasizes diagnostic and therapeutic challenges in imported malaria.

Abstract

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.

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