Case report: 28 year-old female with fever and thrombocytopenia

• Main Author: Lemos, Carlos
• Publication Date: 2018
• Other Authors: Vaz Carneiro, Cristina, Miranda, Ana
• Format: Article
• Language: por
• Source: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Download full: https://doi.org/10.25761/anaisihmt.27

BACKGROUND: Malaria needs to be considered during examination febrile patients who traveled from endemic regions. Current blood cells analyzers are not specifically designed to detect malaria-related abnormalities. Therefore, observation of peripheral blood smear (PBS) is still necessary for malaria diagnosis. CASE PRESENTATION: A 28 year-old female living in Angola attended to a medical appointment witth fever, myalgia, cough, headaches, and diarrhoea. Complete blood count (CBC) has revealed thrombocytopenia (130.000x106/L). Search for Plasmodium spp in PBS was negative and anti- -dengue antibodies also negative. Two days later she traveled to Portugal, where she attended the emergency department. Platelet count has lowered (47.000 x 106/L), there was elevation of transaminases (ALT 124 UI/L, AST 97 UI/L) and C-reactive protein value was 2,66 g/dL. Search for Plasmodium spp and anti-dengue antibodies were again both negative. CBC was repeated 3 days later, which revealed 8% large unstained cells (LUC). A PBS was prepared and some forms of Plasmodium malariae were observed. CONCLUSIONS: Misdiagnosis of imported malaria is not uncommon. Although PBS remains necessary for malaria diagnosis, low parasite densities may initially be undetectable in PBS. Therefore, in patients with suspected malaria suspected, PBS should be repeated every 12-24 hours, for a total of 3 sets.