Ischemic stroke during dengue-Plasmodium vivax coinfection in a young woman: a case report.

BACKGROUND

Malaria and dengue are tropical endemic infections that can cause severe vascular and neurologic complications. Coinfection with Plasmodium vivax and dengue virus is uncommon but increasingly reported in co-endemic areas, complicating diagnosis and suggesting possible pathogenic synergy. Although each pathogen has been linked to stroke, cerebrovascular events during coinfection are exceptionally rare.

CASE PRESENTATION: We describe a 23-year-old Colombian woman, who recently returned from Chocó, and developed acute right-leg monoparesis after 7 days of fever. Exam: hypotension and jaundice. Labs confirmed P. vivax malaria (8200 parasites/μL) and acute dengue (NS1 antigen positive; IgM-positive/IgG-negative). MRI revealed an acute left ACA infarct. There are no traditional stroke risk factors. She received artesunate-primaquine, supportive dengue care, and aspirin after her thrombocytopenia resolved; her neurologic function improved with rehabilitation.

CONCLUSIONS

This case highlights the potential of P. vivax-dengue coinfection to cause ischemic stroke through synergistic endothelial injury. Early recognition, targeted treatment, and coinfection screening are essential in endemic areas, especially during vector expansion.