Severe Plasmodium falciparum malaria: a multisystemic collapse with gangrene, acute kidney injury and seizures

Abstract

Severe Plasmodium falciparum malaria is associated with life-threatening complications due to widespread microvascular dysfunction and multiorgan involvement. While cerebral malaria, acute kidney injury, and acute lung injury are recognized complications, rare manifestations such as peripheral gangrene and subarachnoid hemorrhage are seldom reported. We report the case of a 60-year-old female from rural India who presented with high-grade fever, chills, and respiratory distress. Laboratory evaluation confirmed P. falciparum malaria with severe parasitemia. Her clinical course was complicated by acute lung injury, generalized seizures, subarachnoid hemorrhage, acute kidney injury, coagulopathy, and evolving peripheral gangrene. She required intensive care support, intravenous artesunate, ventilatory assistance, anticonvulsants, and transfusions. Despite developing dry gangrene necessitating partial amputation of fingers, the patient improved with aggressive management and was discharged in stable condition. This case highlights the potential for P. falciparum malaria to cause rare and severe complications, including asymmetrical peripheral gangrene and subarachnoid hemorrhage. Early recognition of atypical manifestations, multidisciplinary care, and timely intervention are crucial for improving survival and reducing morbidity in severe malaria.