Plasmodium falciparum Malaria

presenting with flaccid paraplegia.

INTRODUCTION
Electrolyte disturbances are known complications in patients of
severe malaria. The commonest being serum Na, K along with urea &
creatinine. These feature are more common in falciparum malaria.
However adult patient of falciparum malaria presenting with acute
flaccid paralysis is rare.

CASE REPORT
A 26-year-old male presented at the hospital with complaints of high
grade intermittent fever, with chills, for two days and the sudden
onset of progressive weakness for a day. The fever was not
accompanied by vomiting, diarrhoea or any other systemic
complaints
O/E- he was conscious, oriented. BP100/58mmhg PR110/min temp-
101.1 deg F. General examination icterus present, no pallor/edema.
Respi, cardio, CNS examination revealed no abnormality. P/A- soft,
tender hepato-splenomegaly was present.
LAB INVESTIGATION- Hb- 8.2g/dl,Hct- 24, TLC- 9600/micL, TPC-
86000/micL RBS-78mg/dl urea-68mg/dl Cr-1.6mg/dl ESR 46mm
serum sodium-132 meq/l,potassium-3.6meq/l LDH- 920, LFT showed
indirect hyperbilirubinemia ABG showed acidosis
The patient was started with iv artesunate, iv ceftriaxone, dextrose
containing fluid and symptomatic treatment. The patient improved
clinically. On the third day of admission he had suddenly developed
gradually progressive lower limb weakness leading to an inability to
stand up and walk. He denied any history of recent vaccinations, use
of diuretics, any trauma or seizures. There was neither any history of
a similar weakness in his past nor any family history of it.
neurological examination showed bilateral lower limb flaccid
paralysis with knee and ankle reflexes absent, with absent bilateral
plantar reflexes. CSF analysis was normal, potassium was 1.47 mEq/L.
The ECG showed flattened T waves and the presence of U waves. IV
KCL was given and the patient improved gradually by 6th day of
admission.

DISCUSSION- Clearly the flaccid paralysis was due to hypokalemia

as it improved with KCL infusion. GBS and transverse myelitis in shock
can be potential differential diagnosis. The cause of hypokalemia
might be due to artemisinin therapy or AKI/nephritis due to
falciparum malaria or correction of acidosis or stress induced
increased catecholamine and subsequently reflex insulin secretion.

CONCLUSION- Physicians, especially those in endemic areas of

malaria, must consider motor weakness being caused by
complications secondary to infectious diseases, especially a prevalent
one like malaria. Sr magnesium, potassium and sodium must be
checked regularly.
Key words – Hypokalemia, flaccid paraplegia, falciparum malaria