Severe plasmodium falciparum Malaria Presenting with Jaundice, Persistent Vomiting and Red-Colored Urine: A Case Report

Abstract

Plasmodium falciparum malaria is a potentially life-threatening infectious disease with a broad spectrum of clinical manifestations. Although severe malaria is characterized by specific clinical or biological criteria, patients may initially present with less specific manifestations such as vomiting, jaundice and abnormal urine coloration. Prompt parasitological diagnosis and early effective antimalarial treatment are essential, particularly when oral therapy cannot be reliably administered. A 36-year-old woman , originally from Nigeria, with no significant medical history, presented with a four-day history of vomiting, dizziness, jaundice and red-colored urine in a febrile context. She had travelled to Côte d'Ivoire one week before presentation. At admission, she was afebrile, hemodynamically stable and neurologically intact, with a Glasgow Coma Scale score of 15/15, blood pressure of 120/60 mmHg, heart rate of 91 beats/min, respiratory rate of 12 breaths/min and oxygen saturation of 96% on room air. Laboratory investigations revealed mild anemia (hemoglobin 10.4 g/dL), normal platelet count (170,000/mm³), preserved renal function (creatinine 6.83 mg/L), marked hyperbilirubinemia (total bilirubin 64.1 mg/L, predominantly indirect), elevated lactate dehydrogenase (405 IU/L) and elevated C-reactive protein (102.4 mg/L). Peripheral blood smear demonstrated young ring-form trophozoites and characteristic gametocytes consistent with P. falciparum, with an estimated parasitemia of 1.5%. According to the French criteria applied in this case, clinical jaundice and marked hyperbilirubinemia constituted a criterion of severe malaria.Urinalysis showed red/ictéric urine, negative dipstick blood, 5 red blood cells/mm³ and positive urinary bilirubin.