Abstract. Plasmodium falciparum malaria is associated with procoagulant activity but not with thromboembolism. We measured coagulation factor XIII, i.e., fibrin-stabilizing factor, in 45 patients with falciparum malaria over time. Of these, 22 had organ complications. The factor XIII antigen (subunits A and B) and plasma activity levels were abnormally low in those with falciparum malaria. They increased during antiparasitic therapy. In 14 of 22 patients with complications, but in no patient with mild disease (P Ͻ 0.001), subunit A and activity was Ͻ 50%. The factor X.III levels were inversely correlated with clinical severity, parasitemia, and human neutrophil elastase (HNE), but not with thrombin-antithrombin III levels. Thus, low factor XIII levels may reflect proteolysis by HNE, rather than procoagulant activity. One could speculate that factor XIII degradation in severe malaria prevents thromboembolism. On the other hand, factor XIII deficiency might reduce protection of the vascular endothelium against HNE and reactive oxygen species, which would promote organ damage.

INTRODUCTION:Lung cancer in young non-smokers is rare however it is associated with significant morbidity and mortality. This is further complicated when diagnosis occurs late in the disease course. CASE PRESENTATION:We present the case of a 35 year old female who presented with left sided facial droop and ptosis, blurry vision, and left sided facial and arm numbness that progressively worsened over 3 days. Her past medical history was significant for lower back pain of 4 months duration which prompted two prior emergency department visits. A CT scan of the brain performed in the emergency department on the current visit showed a multifocal hyperdense lesion in the supratentorial and infratentorial parenchyma. This was followed with a contrast MRI that demonstrated at least 63 heterogeneously enhancing intraparenchymal nodules ranging from 1 mm to 25 mm in size. These results prompted a chest x-ray that showed a 9 cm masslike infiltrate in the right upper lobe. A CT of the chest confirmed a 4 cm spiculated mass in the right upper lobe and enlarged paratracheal and sub-carinal lymph nodes. The patient denied any history of smoking or occupational exposures that would predispose for lung cancer and her family history was negative for cancer. A CT guided biopsy was performed on the lung mass and pathology showed Napsin-A positive adenocarcinoma. The patient's neurological symptoms improved with dexamethasone therapy and was discharged to follow with radiation and medical oncology.

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