Malaria and encephalopathy in a heart transplant recipient: A case report in the context of multiorgan donation

Transpl Infect Dis. 2021 Jun;23(3):e13565. doi: 10.1111/tid.13565. Epub 2021 Feb 8.

Abstract

Introduction: Malaria is an endemic infection in tropical circles. It can be transmitted from mosquitoes bite, but exceptional cases have been attributed to multiorgan transplantation.

Case report: This is a 34-year-old woman who received a heart transplant for final-stage dilated cardiomyopathy. Over the hospitalization, she developed fever, cephalalgia, and tonic-clonic seizures with MRI findings compatible with posterior reversible encephalopathy. A thick blood smear revealed hemoparasitic forms of Plasmodium vivax. Afterward, malaria was also diagnosed in recipients of one kidney and liver of the same organ donor. First-line treatment with artesunate was prescribed for 3 days and chloroquine with primaquine thereafter for 14 days. The patient was discharged and returned to the emergency department 5 days later, complaining of gastrointestinal symptoms and developed multiorgan failure that led to death.

Conclusion: We report a case of malaria transmission through heart transplantation. Despite adequate and supervised treatment, it can be related to a fatal outcome. Malaria screening in organ donors should be considered in regions where endemicity can lead to rare cases of transmission by transplantation.

Keywords: heart transplant; malaria; posterior reversible encephalopathy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Animals
  • Antimalarials / therapeutic use
  • Brain Diseases* / drug therapy
  • Female
  • Heart Transplantation*
  • Humans
  • Malaria* / drug therapy
  • Primaquine / therapeutic use

Substances

  • Antimalarials
  • Primaquine