A case report of pitfall of fever and altered mental status: cerebral malaria due to in an adult traveler returning from Congo

Abstract

Background Cerebral malaria, caused by Plasmodium falciparum, can lead to severe neurological complications. It is more frequently observed in children than in adults. Because cerebral malaria is rare and has no specific symptoms or neurologic findings, it is not easy to diagnose. Case report We report a case of a 61-year-old male who returned from the Democratic Republic of the Congo with fever, fatigue, and confusion. With considering cerebral malaria, a peripheral blood smear confirmed P. falciparum infection (initial parasite load, 760,800/μL; ring form, 100%). Cerebrospinal fluid analyses showed high protein level (103.2 mg/dL). Electroencephalograms showed background slowing activity. Brain magnetic resonance imaging showed signal changes and cerebral swelling. The initial doxycycline and quinidine treatment for malaria was successful without sequalae. Conclusion Physicians must have high suspicion about the symptoms and the necessity for screening in individuals traveling to malaria-endemic regions when experiencing changes in consciousness.

Keywords

• malaria
• cerebral malaria
• altered mental status
• doxycycline
• quinidine