Case Report: An Adolescent Girl with Isolated Neuropsychiatric Features and Apparent Post-Malaria Neurological Syndrome

Abstract

The post-malaria neurological syndrome (PMNS) is an unusual and relatively underreported complication of malaria, which usually occurs after the resolution of acute febrile illness and the patient is free from parasitemia. The clinical spectrum of the PMNS varies from acute-onset cerebellar ataxia to significant encephalopathy with focal deficits resembling acute disseminated encephalomyelitis. Uncommon presentations of PMNS include Guillain-Barre syndrome, postural tremor, or even isolated neuropsychiatric features. Although in a significant proportion of PMNS cases clinical resolution occurs with conservative treatment only, corticosteroids have been used in an attempt to hasten recoveries. Here, we present a case of a 12-year-old girl with acute onset, isolated neuropsychiatric features, following Plasmodium falciparum malaria. Neuroimaging, clinical examination, and cerebrospinal fluid studies were within normal limits. The child recovered completely after treatment with methylprednisolone pulse therapy. This case report illustrates the need for creating awareness about this uncommon complication of malaria. In view of the uncommon complication, early diagnosis and prompt treatment might help in the early resolution of symptoms.

Clinical presentation and immunological features of Post-Malaria Neurologic Syndrome: a case report and review of literature

“…The differential diagnosis between PMNS and CM- related illness relies on the time of onset and the presence of parasitaemia [ 7 , 8 ]. It should be also pointed out that, apart from these main four patterns, PMNS could anecdotally manifest with isolated non-specific neuropsychiatric features, generalized myoclonus and postural tremors [ 9 , 10 ].…”

Post-Malaria Neurological Syndrome (PMNS): a rare case report with brain biopsy findings

“…However, this would require a prolonged persistent infection or relapse which by default would not t under the de nition of PMNS [8], another theory about structural aberrations caused by the recent malaria infection could explain the pathogenesis. However, the hallmark of rapid and complete resolution of the symptoms and the time frame makes it unlikely [3,11]. Other possibilities like co-infection with a viral agent that precipitates encephalitis or neurotoxicity as an adverse drug reaction [5].…”

“…PMNS on the other hand is the development of new neurological manifestations in patients who had recent malaria infection with successful treatment, PMNS is a relatively new phenomenon [1], with low incidence, the presentation has a wide range of neurological signs and symptoms from headache to seizure, confusion, and loss of consciousness, a set of criteria was suggested to aid in the diagnosis of PMNS; requiring a recent infection with malaria that successfully treated proven by malaria negative smear, and a symptoms-free period after malaria cure [2]. Before considering PMNS all effort must be done to rule out all other causes that can explain the patient presentation, The presence of abnormal brain imaging ndings was reported in up to half of the cases with PMNS with no speci c pattern or distribution [3], almost all of the cases showed neurological improvement and resolution of all symptoms without remaining de cit, although steroid was used in some severe cases to fasten the recovery. However, its use is still debated whether it has a role in the improvement of these cases [1,4].…”

Neurological manifestations following cured malaria: don’t forget post-malaria neurological syndrome

“…It is a rare condition with an incidence of 1.2–1.7 per 1000 malaria cases 4 , 5 . Until February 2020, only 54 cases of PMNS were reported including 28 of them were isolated case reports 3 , 5 , 6 . In two recent systematic reviews, most cases of PMNS were observed in young adult males (mean age, 33 years) and preceded by severe Plasmodium falciparum malaria.…”