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.