Discussion
The five species of Plasmodium that cause malaria in humans are
Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium
malariae, and Plasmodium knowlesi. Plasmodium falciparum causes the
highest disease burden, followed by Plasmodium vivax [8, 9]. Severe
malaria is usually caused by Plasmodium falciparum; however, severe
malaria and even death can occur in patients infected with Plasmodium
vivax [3, 10].
The traditional thought that Plasmodium vivax is a benign disease is
changing, and severe Plasmodium vivax malaria has been reported in
recent years. Reported serious manifestations include liver dysfunction,
cerebral malaria, death, severe anemia, severe thrombocytopenia,
respiratory distress, disseminated intravascular coagulation, renal
dysfunction, hypoglycemia, generalized seizures, shock, and
hemoglobinuria and metabolic acidosis [11].
Three cases of intracranial venous thrombosis (a case of cerebral venous
thrombosis and two cases of sagittal sinus thrombosis) caused by
Plasmodium falciparum and Plasmodium vivax have been reported from
India. Two of the three patients had mixed Plasmodium faciarum and vivax
infection. A hypercoagulable state secondary to severe malaria is
thought to have been the cause of this rare and potentially fatal
complication [4]. In addition, there were additional case reports of
cerebral venous thrombosis in patients with Plasmodium vivax malaria
among patients from India [5] and there was a case report sagittal
sinus thrombosis associated with severe Plasmodium vivax in a patient
from from Columba [6].
There was only a case report of massive venous thromboembolism caused by
disseminated intravascular coagulation due to severe Plasmodium
falciparum malaria [7]. In contrast to this case report, our patient
had Plasmodium vivax malaria and no evidence of disseminated
intravascular coagulation. Although the pathogenesis of pulmonary
thromboembolism in our patient remained unclear, it may be related to
hypercoagulable conditions with a pathophysiological mechanism similar
to Plasmodium falciparum malaria [4].
Our patient was young, and he had no identified risk factors for
thrombosis. Hence, we believe that our patient’s pulmonary
thromboembolism is most likely secondary to hypercoagulabe state induced
by Plasmodium vivax malaria.