Severe Plasmodium Vivax Malaria Presenting with Acute Kidney Injury and Sepsis

Abstract

Plasmodium vivax malaria is generally considered milder than P. falciparum, but in rare cases can result in severe, life-threatening complications such as acute kidney injury (AKI), severe electrolyte disturbances, hematologic abnormalities, and secondary infections, which increase morbidity and complicate management. A 31-year-old man presented with persistent cough, fever, and generalized weakness. He had a history of malaria and tested positive for IgM Plasmodium vivax, while peripheral smear and PCR were negative. On admission, he was moderately ill, showing pale conjunctiva and mild epigastric tenderness. Laboratory tests revealed severe normochromic normocytic anemia (Hb 5 g/dL), persistent thrombocytopenia (23 x10³/µL), marked elevation of urea (328 mg/dL) and creatinine (36.8 mg/dL), severe hyperkalemia (8.8 mmol/L), hyponatremia (124 mmol/L), mild hypocalcemia, and metabolic acidosis. Imaging revealed bilateral pneumonia and parenchymal renal disease with hepatomegaly, cholecystitis, and left pleural effusion. He was also diagnosed with community-acquired pneumonia (PSI 142) and sepsis. Management included urgent serial hemodialysis, multiple transfusions, intravenous artesunate followed by dihydroartemisinin-piperaquine and primaquine, and broad-spectrum antibiotics. The patient improved clinically and biochemically, with normalization of electrolytes, improved renal function, and resolution of symptoms. Severe P. vivax malaria can present with multi-organ dysfunction, and early, comprehensive, multidisciplinary management is essential, especially when laboratory confirmation is inconclusive.