급성 신부전, 황달 및 혈소판 감소증이 병발된 일열 말라리아 1예

Purpose: Malaria is caused by four species of the genus Plasmodium. Plasmodium vivax malaria is the most common malarial infection in Korea and usually has benign clinical course. However, serious complications such as severe anemia, pulmonary edema, acute renal failure are reported in Plasmodium vivax malaria. We report a case of Plasmodium vivax malaria complicated with acute renal failure, jaundice and thrombocytopenia. A 56-year-old male was transferred to our hospital with acute renal failure, jaundice and thrombocytopenia. 10 days before admission, he had intermittent fever, chill, myalgia, and was treated with some medications under the impression of URI. Laboratory findings showed that hemoglobin was 11.5 g/dL, platelet 44,000/mm3, blood urea nitrogen 73 mg/dL, creatinine 4.0 mg/dL, total bilirubin 5.2 mg/dL, direct bilirubin 4.0 mg/dL. Serologic tests for leptospirosis, rickettsia, EB virus and CMV were negative. Ring form trophozoites were found in red blood cells, suggesting Plasmodium vivax malaria. Following anti-malarial therapy, acute renal failure, jaundice and thrombocytopenia were recovered to normal. From this case, malarial infection should be included as a differential diagnosis in a febrile patient with acute renal failure, jaundice and thrombocytopenia.