A CASE OF SCAD (SPONTANEOUS CORONARY ARTERY DISSECTION) IN A YOUNG FEMALE WITH RECURRENT INTRACTABLE NAUSEA AND VOMITING

Document Type

Conference Proceeding

Publication Date

7-17-2025

Publication Title

J Gen Intern Med

Keywords

Health Care Sciences & Services, General & Internal Medicine

Abstract

CASE: 25-year-old Wolof-speaking male who recently arrived from Senegal with a remote history of malaria (unclear treatment, no hospitalization) presented to the emergency room with a three-day history of dull global headache, abdominal pain, vomiting, watery diarrhea, and hematuria. Upon arrival, he was noted to be diaphoretic, dehydrated, tachycardic and hypoglycemic. Labs were pertinent for severe thrombocytopenia with a platelet of 15, lactic acidosis, indirect hyperbilirubinemia, severe acute kidney injury (AKI), and parasite smear with 40% RBCs Plasmodium Falciparum. Given the considerable parasite burden, he was admitted to the hospital. After several hours, he became lethargic and minimally responsive, febrile to 104.1F, hypoxic, and found to be acutely anemic with a hemoglobin of 5.9. He was transferred to the intensive care unit (ICU) with a guarded prognosis. Thereafter, following the completion of two doses of IV artesunate, he had rapid improvement including resolution of fever, AKI, thrombocytopenia, and reduction in parasite burden to 11.2%. He was transitioned to oral artemether-lumefantrine for three days. Repeat parasite smear showed no parasitemia and he was discharged home. IMPACT/DISCUSSION: Malaria is a potentially serious and life-threatening mosquito-borne infectious disease caused by Plasmodium parasites, which affects red blood cells. Plasmodium falciparum remains the most dangerous species, responsible for the greatest number of severe cases and deaths. Less than 1% of cases are classified as ’severe malaria‘, defined as hyperparasitemia with signs of organ dysfunction. Such signs are the result of parasitized red blood cells adhering to the endothelial cells lining small blood vessels causing small infarcts, capillary leakage and massive intravascular hemolysis. This clinical vignette illustrates the potential of malaria to progress rapidly to life-threatening multi-organ dysfunction, in this case, becoming unresponsive and hypoxic within hours of presentation. Concurrently, the very quick response to Artemisinin-based combination therapy (ACT) resulted in clearance of parasitemia within 12-24 hours of ACT initiation. CONCLUSION: In this report, we present a case of severe malaria in a young male, compounded by severe AKI, hypoglycemia and thrombocytopenia. The potential for rapid deterioration underscores the rationale of frequent clinical and laboratory assessments, and the rapid response to ACT highlights the importance of administering ACT promptly.

Volume

40

First Page

S97

Last Page

S98

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