Acute severe pancreatitis in falciparum malaria

Abstract

Though different organs have been involved in falciparum malaria, pancreas has not been a common organ involved so far. Pancreatitis is a rare complication of Plasmodium falciparum malaria. The patient was admitted with low Glasgow Coma Scale and was febrile and in hypotension, and with oral bleeding. Preliminary investigations revealed leukocytosis, severe anemia, low platelet count, abnormal renal function test, deranged liver enzymes with conjugated hyperbilirubinemia, raised international normalized ratio, and hypoalbuminemia. Arterial blood gas showed metabolic acidosis. The raised pancreatic enzymes with radiological evidence of pancreatitis helped establish the diagnosis. Patient's condition improved with antimalarial, blood transfusion, circulatory support, and hemodialysis. The most possible mechanism of pancreatitis in malaria is microvascular occlusion with resultant ischemia, activation of pancreatic enzymes, and injury to pancreas due to autodigestion. Prognosis was good in our case of malarial pancreatitis.