Wellington Case Report.Cerebral Malaria Complicated by Multi-Organ Failure





Diagnosis: Cerebral Malaria complicated by multi organ failure


History and Presentation:


Above name patient was admitted semi conscious, initially suspected to be CVA but Urgent CT did not how any evidence of stroke. He was said to have slumped 12 hrs prior to presentation and was taken to Garki hospitals by passerby. No other history available

He is not a known hypertensive, diabetic


Temp: 37.6C.  PR: 105BPM


Currently GCS: E-4, M-4 V- 1

Pupils- 3mm sluggishly reactive


Chest: Acidotic breath, Appears slightly labored breathing

            RR -21cpm Spo2: 99% on O2 facemask.

           Transmitted sounds.


Abdomen: FMR, no palpable organomegly

Urinary- deep amber concentrated urine 200mls in the last 3 hrs




Laboratory investigations on admission

FBC: wbc- 2.24, pcv- 39.80, plt- 12

EUCR: Na- 141.2, k- 5.47, ur- 131.9, Cr- 3.93mg/dl

MP:  +++ seen

FLP: hdl- 6.02

Serology: HbsAg- reactive

Clotting profile: inr- 1.0, apt- 29.1, pt- 13.4

RBS: 5.4mmol/L




ABD USS: suggests

a.       ? fatty liver r/o ? hepatitis

b.      Splenomegaly

c.       Cystitis ? UTI


Diagnosis: Cerebral Malaria complicated by multi organ failure



Management plan:

·         Monitor neurovital signs closely

·         Monitor Input/Output

·         IVF N/S 1L alternate with 5% D/S 8hrly

·         IV ceftriaxone 1g 12hrly

·         IV metronidazole 500mg 8hrly

·         Tabs keppra 2g stat, then 1g bd.






 A 52 year old police officer, who was brought in unconscious for about 12 hours duration. Patient was noticed to have lapsed into unconsciousness and was taked to a sister hospital from where he was referred here.

Detailed history would not be ascertained.

On examination: patient was noticed to be jaundiced with grunting respiration, moderate pedal edema.

GCS: 10/15, no lateralizing sign.

Abdomen: nil of note.


Assessment: toxic hepatopathy r/o hepatitis B viral infection


1.      Repeat LFT

2.      5 panel test for hepatitis B

3.      IVF 10% D/W 1L 8hrly x 24hrs then, 500mls 5% D/W 8hrly

4.      IV frusemide 20mg

5.      Tab spironolactone 100mg daily

6.      In the event of bleeding, GXM fresh whole blood

7.      Glucose monitoring.







Thanks for asking me to see this 52 year old male who had slumped 48hrs ago. He was noticed to have thrombocytopenia, mild anemia, and leukopenia. No bleeding from any orifice. Most history not available as he resides alone in Abuja.

Other lab results noted. HbsAg positive. PT and PTTK are normal.

O/E: unconscious, oxygen mask, afebrile, nil purpura.

Ass: pancytopenia ? 2ry to HBV infection.



1.      Urinalysis, HbsAg core antigen test, blood film to be reviewed by hematologist.

2.      Withhold any antiplatelets, to be reviewed with blood film result




Blood film report:  

a.       Red blood cell: normocytic, normochromic, few target cells, burr cells. Majority of red blood cells have inclusion of malaria parasite.

b.      White blood cell: slightly reduced on film with neutrophilia

c.       Platelets: reduced on film, few larger foons.

Impression: significant high malaria parasitemia suggestive of cerebral malaria.







UPDATE 23/7/23

Hematology review noted.

Patient was commenced on IV artesunate 120mg and has received 2 doses. Patient has not produced enough amount of urine.

Severely icteric and pale. Constantly having hiccups.


Ass: cerebral malaria with background multi-organ failure


1.      To transfuse with 2 units of blood

2.      For hemodialysis





UPDATE 24/7/23

A case of black water fever currently complicated by cerebral malaria (deeply unconscious) and AKI( scanty coke coloured urine). He made only 50mls of urine in the last 24hrs despite receiving 5 liters of fluid and high dose lasix.



1.      Repeat EUCR

2.      Refer patient for hemodialysis.

3.      IV 10% calcium gluconate 10mls stat.





Kindly revert to us for clarifications where necessary.

Yours Sincerely,



Dr. Ukandu Chinedu

For Team Wellington Clinics Abuja





22 Nov, 2023
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