Sudden death due to cerebral malaria in a Nigerian adult: a rare post mortem finding.
Sunday Soyemi, Adedayo Faduyile, Olajide Lawal, Adokie Benebo, John Obafunwa and Victor Mordi
World Journal of Pathology 2013, 2:8
Cerebral malaria is uncommonly diagnosed amongst adult in endemic areas in Africa and South-East Asia. It is the most common neurological complication of plasmodium falciparum malaria. It has few specific clinical symptoms with differences in presentation between children and adults. Sequestration of infected red blood cells within cerebral vessels is the main pathological basis of this disease.
We present a case of a- 45 year old Nigerian who died of cerebral malaria despite living all his life in Nigeria (A malaria endemic area for years). Investigation also did not reveal any form of immune suppression.
In this case, autopsy findings show enlarged salty-grey liver and brain with global punctuate hemorrhages in the grey and white matter. Cut surfaces of the slightly enlarged spleen revealed dark red diffluent.
Histopathological examination revealed the presence of parasitized red blood cells with malaria pigment (haemozoin) in blood capillaries within the brain and the lungs.
This case presents a paradox that contradicts the epidemiological impression that the development of immunity during childhood offers protection against severe infection in adult life. It is also presented for pathologists, most importantly forensic pathologist to bear in mind the possibility of an elderly person having cerebral malaria as a cause of sudden death in malaria endemic regions.
Cerebral malaria, P. Falciparum, parasitized red blood cells.