We Still Have to Fear Malaria: A Case Report of Severe Malaria With Almost all the Listed WHO Complications in a Patient Living in a Sub-Saharan Endemic Area.

BACKGROUND: Malaria is a common and potentially deadly infection in Sub-Saharan Africa, causing nearly 600,000 deaths. Despite improvements in treatment and prevention, it continues to wreak havoc, particularly in this region, which accounts for more than 95% of cases. Individuals living in malaria-endemic areas traditionally have a lower risk of developing severe malaria.

CASE PRESENTATION: We report a case of a 67-year-old woman with hypertension and bilateral knee osteoarthritis. She was referred from a health center due to confusion and abnormal movements in a febrile context. Findings upon admission revealed a patient with a poor general state, an inflammatory syndrome, a confusional syndrome, a cortical irritation syndrome, a hemolytic anemia, and a severe hypoglycemia. Both the rapid diagnostic test and the thick blood smear for malaria were positive. The clinical course was marked by persistent signs of hemolysis and hypoglycemia, status epilepticus, deep coma, the development of diffuse ecchymoses, digital ischemia and Stage 2 pressure ulcers, worsening of respiratory failure, hepatocellular failure, acute kidney injury, and hyperkalemia reaching 6.24 mmol/L. Therapeutic interventions led to significant improvements in the patient's level of consciousness, resolution of status epilepticus, correction of hypoglycemia, and attenuation of hemolysis, although acute kidney injury persisted, requiring extrarenal epuration. Despite improvements in consciousness and correction of respiratory, liver, and kidney function, the patient ultimately succumbed to sepsis before digital amputation could be performed.

CONCLUSION: This case serves as a reminder of the severe complications and potential fatality associated with malaria. Emphasis must be placed on prevention.