Coronavirus disease 2019 and malaria coinfection in a middle-aged Ethiopian woman presenting with acute febrile illness and bilateral pleural effusion: a case report

Abstract

Introduction: There could be misdiagnosis of coronavirus disease 2019 for malaria and vice versa because of their similar presentations, particularly when clinicians rely mainly on symptoms for diagnosis. Coinfection with coronavirus disease 2019 and malaria is associated with increased all-cause in-hospital mortality compared with isolated infection with severe acute respiratory syndrome coronavirus 2. Presentation with pleural effusion adds another challenge in the diagnosis of coronavirus disease 2019.

Case presentation: This is a 57-year-old black Ethiopian woman who presented with symptoms of acute febrile illness associated with shortness of breath and coughing. Physical examination was remarkable for fever, hypotension, tachycardia, tachypnea, oxygen desaturation, decreased air entry, and dullness over bilateral lower one-third of the chest. Peripheral blood smear revealed ring-form trophozoites of Plasmodium falciparum; chest X-ray showed bilateral pleural effusion and chest computed tomography revealed bilateral ground-glass opacities and consolidations involving all lung zones with bilateral moderate pleural effusion. She was managed with supportive treatments, antimalarial agents, and antibiotics. Rapid antigen test for severe acute respiratory syndrome coronavirus 2 was negative at the time of her presentation to the emergency department, but polymerase chain reaction testing for coronavirus disease 2019 turned out to be positive after admission to the medical ward.

Conclusion: Clinicians should be aware of the possibility of coronavirus disease 2019 and malaria coinfection in any patient who is from malaria-endemic area and presenting with acute febrile illness symptoms such as fever and headache and respiratory complaints like shortness of breath and cough. Alhough viral etiologies such as coronavirus disease 2019 are rare causes of bilateral pleural effusion, they should be considered after ruling out other common causes.

Keywords: COVID-19; Malaria; Pleural effusion.

Fig. 1

Serial chest X-ray images. A Symmetrical bilateral pleural effusion; B bilateral pleural effusion greater on the left side; C significant improvement, except for left basal haziness