Subcapsular Splenic Hemorrhage in Vivax Malaria

Abstract

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.

Keywords: Plasmodium vivax; hemorrhage; malaria; spleen; splenic rupture.

Fig. 1

(A) Changes in splenic hemorrhage over time in Case 1: Subcapular hemorrhage of the spleen was found, without rupture. The subcapsular hemorrhage was absorbed slowly, over 118 days. (B) CT finding in Case 2: Subcapular hemorrhage with hemoperitoneum. (C) CT finding and coil embolization for splenic rupture in Case 3. White arrows: subcapsular hemorrhage. Black arrows: hemoperitoneum.