• Johanna Eggeling, Michael Ramharter, Dominic Wichmann, and Stefan Schmiedel.
• Universitätsklinikum Hamburg-Eppendorf, I. Medizinische Klinik und Poliklinik, Sektion Infektiologie, Hamburg.
• Dtsch. Med. Wochenschr. 2024 Sep 1; 149 (18): 109010931090-1093.

Medical History A 25-year-old female outpatient presenting with fever and micro-hematuria was treated for urinary tract infection. Her condition worsened over 3 days at home. After experiencing multiple falls caused by leg weakness and mental confusion, she was admitted to a hospital with high fever.Diagnostics Initial laboratory findings showed hemolytic anemia, pancytopenia, and acute kidney injury, suggesting hemolytic uremic syndrome. However, a detailed fever evaluation revealed her recent return from Afrika. This prompted a malaria test, which confirmed Plasmodium falciparum infection with 80 % parasitemia.Therapy And Progress Despite the quick reduction of parasitemia following treatment with intravenous administered artesunate and oral Artemether-Lumefantrine, her condition worsened, leading to a septic shock. This required renal replacement and kinetic ventilation therapy, as well as blood transfusions due to persistent hemolysis until the laboratory values normalized after 48 days post-admission.Conclusion The evaluation of fever is often challenging, but most often a detailed patient history is key to early diagnosis and treatment preventing deathly outcomes in severe cases.Thieme. All rights reserved.

24 keywords...

hide…