A Case of Plasmodium vivax-Induced Stress Cardiomyopathy Managed With Extracorporeal Membrane Oxygenation

Abstract

Acute respiratory distress syndrome (ARDS) and cardiomyopathy can occur as severe manifestations of malarial infections. We present a case of a 20-year-old male who, after recently returning from Nigeria, presented to our hospital with flu-like symptoms and was ultimately diagnosed with Plasmodium vivax infection. He developed severe ARDS and failed conservative management with lung-protective ventilation, steroids, and inhaled pulmonary vasodilators. Given the severity of his disease, he was placed on venovenous extracorporeal membrane oxygenation (ECMO) to provide further pulmonary support. He subsequently developed acute stress cardiomyopathy with severe biventricular failure that did not respond to high-dose vasopressor and inotropic therapy. His cannula configuration was adjusted to veno-arterial-venous (VAV) ECMO to provide additional hemodynamic support. During this time, the patient had been receiving treatment with artesunate. After a total of seven days on ECMO, he was successfully decannulated and safely discharged home with oral antimalarial treatment.

Keywords: ards (acute respiratory distress syndrome); plasmodium vivax malaria; short term mechanical circulatory support; stress cardiomyopathy; takostubo cardiomyopathy; veno-arterial ecmo; vv ecmo.

Figure 1. Bilateral Lung Whiteout

Figure 2. Improved Alveolar Recruitment After APRV

APRV: airway pressure release ventilation