Steroid Pulse Therapy May Mitigate Prolonged Neurological Manifestations after Eradication of Severe Plasmodium falciparum Parasitemia

Abstract

A 58-year-old Japanese man with a high parasitemia of Plasmodium falciparum, returning from Uganda, was admitted to our hospital since his consciousness level rapidly deteriorated after the initial dose of mefloquine. Despite the parasitemia was cleared by quinine by day 7, the coma remained unchanged and diffuse leukoencephalopathy was detected on magnetic resonance image. Steroid pulse therapy was initiated on day 8. Subsequently, the neurological manifestations improved and he was discharged on day 73 without any sequelae. Pathogenesis of P. falciparum causing cerebral malaria is diverse and complex. If neurological symptoms unusually prolong, steroid may be an effective treatment option.

Figure 1.

Blood smears. Each sample was taken one day before admission (A), on hospital day 1 (B), day 3 (C) and day 7 (D) respectively. The ratios of paracitemia are 30% (A), 16% (B), 0.3% (C) and 0% (D) respectively.

Figure 2.

Time course of MRI. Fluid-attenuation inversion recovery (FLAIR) images showed diffusely increased signal intensity in cerebral white matter on hospital day 7 (A) and this changes was improving gradually, on day 20 (B), day 36 (C) and day 48 (D).

Figure 3.

Time course of electroencephalography (EEG: mono polar 1). EEG on hospital day 7 (A) revealed generally slow waves with theta waves in the frontal lobe (open circle) (channel 5 was not recorded due to recorder trouble). Theta waves in the frontal lobe disappeared on day 20 (B) and background frequency recovered on day 58 (C).