Fulminating Viral Hepatitis Associated with Acute Falciparum Malaria.

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.