Abstract:
After 6 months residence in Ghana a 41-year old
Non-Ghanaians developed a febrile illness which
Proved at the outset to be malaria with heavy falciparum parasitaemia. Despite prompt treatment
with adequate doses of parenteral chloroquine the
illness and fever persisted jaundice was noticed
within one week of onset of the illness. Liver function
tests revealed evidence of severe hepatitis with
positive Hepatitis -B surface antigen clinical
evidence of hepato-cellular failure manifested by
hepatic flap. rapidly accumulating ascites. in addition
to the jaundice was followed by confusion
coma and death within 48 hours of onset jaundice
Post mortem examination showed an enlarged
liver with fulminating necrotic hepatitis ascites.
and an enlarged fluffy and friable spleen
which disintegrated on handling. The hypothesis
that the fulminating nature of the hepatitis Was
facilitated by malaria-induced immuno-suppression
referable to splenic disruption is discussed.