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Weekly Chest CasesArchive of Old Cases

Case No : 616 Date 2009-08-16

  • Courtesy of Ji Eun Nam, Hua Sun kim, Kyu-Ok Choe / Yonsei University College of Medicine
  • Age/Sex 53 / M
  • Chief ComplaintCC: Cyclic fever for 8 days PHx: HTN on PO medication Lab: WBC 4450(neutrophil 75.5%)
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2009-04-19

Diagnosis With Brief Discussion

Diagnosis
Pulmonary edema in Malaria (P.vivax)
Radiologic Findings
The initial chest PA shows diffuse ground glass opacities in both lungs.

Chest CT shows minimal interlobular septal thickenings and bilateral minimal pleural effusion, suggesting mild pulmonary edema.

On follow up chest PA shows rapidly improved GGOs and bilateral pleural effusion, suggesting pulmonary edema.

The peripheral blood smear showed typical ring form trophozoites.

Brief Review
Malaria is caused by four species of Plasmodia; P. falciparum, P. vivax, P. ovale, and P. malariae. Fever with chills, sweating, anemia, leucopenia, and splenomegaly are the mot common clinical findings. Typical clinical symptom are periodicity of the episodic fever (tertian or quartan), every 48 and 72 hours. Reported complication of malaria include pulmonary disease, CNS dysfunction, nephrotic syndome, coagulation abnormalities, bone marrow hyperplasia and spleenic rupture. Pulmonary complications with malaria range from simple respiratory symptoms to reported of pulmonary edema and ARDS. A few reports of acute pulmonary edema associated with quinine therapy have been reported.Severe P falciparum infections is the type most commonly associated with ARDS, but cases caused by P vivax and P ovale habe also been reported. Radiographic and CT findings are consistent with noncardiogenic pulmonary edema, pleural effusion, diffuse interstitial edema, and lobar consolidation may also be seen. Occasionally, bronchiolitis obliterans organizing pneumonia has been reported. The current hypothesis of pulmonary edema and ARDS in malaria are primary lung injury, changes result from vascular injury related to red blood cell sequestration and destruction, the release of parasite and erythrocyte material into the circulation, and the host response to these event.

Please refer to
Case 485,
References
1. C.Illamperuma, B.L.Allen, Pulmonary edema due to plasmodium vivax malaria in a American missionary, Infection 2007;35:374-376

2. Santiago Martinez, G,Santiago Restrepo, Forge A. Carrillo et al. Thoracic manifestations of Tropical parasitic infection; A pictorial reviews. Radiographics 2005;25:135-155
Keywords
Lung, Infection, Permeability edema, Protozoal infection,

No. of Applicants : 72

▶ Correct Answer : 16/72,  22.2%
  • - Osaka University , Japan Osamu Honda
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - CHRU Lille , France Benjamin Damarey
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - kims,narkatpally , India k bhaskar
  • - IRSA , France jean-Luc BIGOT
  • - Yonsei University College of Medicine , Korea (South) Young Joo Suh
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - All India Institute of medical sciences , India Justin Moses
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
▶ Correct Answer as Differential Diagnosis : 19/72,  26.4%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - khartoum university sudan college of post graduate , Saudi Arabia elbagir nasser
  • - Seoul National University Bundang Hospital , Korea (South) Kwang Nam Jin
  • - hospital Sao Paulo , Brazil israel missrie
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - SMC , Korea (South) Jihoon Cha
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - CHU Grenoble , France Fabrice Bing
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Semi-Correct Answer : 4/72,  5.6%
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRCCS Istituto Oncologico Bari , Italy Carlo Florio
  • - Asan Medical Center , Korea (South) Seong Yun Kim
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
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