Steroid Pulse Therapy May Mitigate Prolonged Neurological Manifestations after Eradication of Severe <i>Plasmodium falciparum</i> Parasitemia

Abstract

A 58-year-old Japanese man with a high parasitemia of Plasmodium falciparum, returning from Uganda, was admitted to our hospital since his consciousness level rapidly deteriorated after the initial dose of mefloquine. Despite the parasitemia was cleared by quinine by day 7, the coma remained unchanged and diffuse leukoencephalopathy was detected on magnetic resonance image. Steroid pulse therapy was initiated on day 8. Subsequently, the neurological manifestations improved and he was discharged on day 73 without any sequelae. Pathogenesis of P. falciparum causing cerebral malaria is diverse and complex. If neurological symptoms unusually prolong, steroid may be an effective treatment option.

Collapsing Focal Segmental Glomerulosclerosis with Acute Interstitial Nephritis Associated with Plasmodium Falciparum: A Case Report and Review of the Literature

“…Treatment with corticosteroids should be considered only when given as therapy for extrarenal manifestations after the parasite is eradicated. For example, corticosteroids have been utilized in the treatment of encephalitis and in the hemophagocytic syndrome accompanying malaria [12,13].…”