Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding.

Ramaswami A, Pisharam JK, Aung H, Kafeel G, Maboud K, Chong VH, Tan J.

Am J Case Rep 2013;14:CR103-105 DOI: 10.12659/AJCR.883879

ABSTRACT

Background: Plasmodium knowlesi is frequently reported in Southeast Asian countries and is now widely regarded as the fifth malarial parasite. Mucormycosis is a rare fungal infection that can occur in patients with a weakened immune system.

Case Report: We report a case of acute kidney injury secondary to Plasmodium knowlesi malaria infection and mucormycosis fungal infection. In addition, the patient also had lower gastrointestinal bleeding from invasive gastrointestinal mucormycosis. P. knowlesi infection was diagnosed by blood film and mucormycosis was diagnosed by histopathological examination of biopsy specimen of the colon. The patient recovered with antimalarial treatment (Quinine), antifungal treatment (Lipophilic Amphotericin), and supportive hemodialysis treatment.

Conclusions: We hypothesize that P. knowlesi malarial infection can lower the immunologic threshold and predisposes vulnerable individuals to rare disseminated fungal infections. To the best of our knowledge, this is the first P. Knowlesi malaria associated invasive fungal infection reported in the literature.

Correspondence: Jackson Tan. Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam.

E mail: drjacksontan@yahoo.co.uk