Unusual Clinical Presentation of Congenital Malaria: Cholestasis in Newborn-Advanced Research in Gastroenterology & Hepatology-Juniper Publishers


JUNIPER PUBLISHERS- Advanced Research in Gastroenterology & Hepatology



UNUSUAL CLINICAL PRESENTATION OF CONGENITAL MALARIA: CHOLESTASIS IN NEWBORN

Authored by Sharat Varma

Background

Malaria in the newborn is known to present with a myriad of clinical features including anemia, unconjugated jaundice, fever and lethargy. Cholestatic jaundice is not a reported presentation of malaria in the newborn. This case report highlights a new presentation of malaria in an infant and also a new dimension to evaluation of cholestatic jaundice in this age group. It also demonstrates how basic investigations are often overlooked but of immense importance.

Case Presentation

3 months old child was referred with cholestatic jaundice since 1 month. No history of pale colored stools, fever, lethargy, poor feeding was present. On examination jaundice and spleno-hepatomegaly was present and no evidence of ophthalmologic abnormalities. Investigations showed conjugated hyperbilirubinemia, transaminitis and normal INR, protein and albumin. Ultrasonography showed a well-distended gall bladder, HIDA was excretory, work up for Galactosemia, Tyrosinemia, hypothyroidism, Iron storage disorder and sepsis were negative. The mother was diagnosed to be having malaria in the eighth month of pregnancy and recurrence three months later; the child was evaluated for malaria. His peripheral smear showed trophozoites, schizonts and gametocytes of Plasmodium vivax. There were 1760 parasites/ml on quantification. Consequently the child was given chloroquine and primaquin treatment. Two weeks after receiving chloroquine treatment the jaundice has remitted and splenomegaly regressed.

Conclusion

Malaria in the newborn has few symptoms and may present as cholestatic jaundice alone. Congenital malaria should be kept in the differential diagnosis when malaria has been diagnosed in the mother in the antenatal period. Response to standard chloroquine treatment in congenital malaria has been seen to be effective in our setting. Basic investigations need to evaluated completely before specialized investigations are ordered.



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