Case Report: Plasmodium knowlesi Infection with Rhabdomyolysis in a Japanese Traveler to Palawan, the Philippines

Am J Trop Med Hyg. 2018 Oct;99(4):967-969. doi: 10.4269/ajtmh.18-0348.

Abstract

Skeletal muscle is known to be damaged by falciparum malaria via sequestration of infected erythrocytes. We present a case of rhabdomyolysis caused by Plasmodium knowlesi infection. The patient had fever, myalgia, and muscle weakness 5 days after returning to Japan from Palawan, the Philippines. Blood test revealed thrombocytopenia and an elevated creatine kinase level. Although rhabdomyolysis resolved with fluid therapy, fever of 24-hour cycle continued and thrombocytopenia intensified. On day 7 of illness, Giemsa-stained thin blood smear revealed malaria parasites, with a parasite count of 2,380/μL, which were morphologically indistinguishable between P. knowlesi and Plasmodium malariae. Rapid diagnostic test showed a negative result. The pathogen was later confirmed to be P. knowlesi by nested polymerase chain reaction (PCR). The patient was successfully treated with artemether/lumefantrine. This case suggests that knowlesi malaria might be able to cause skeletal muscle damage.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antimalarials / therapeutic use
  • Artemether, Lumefantrine Drug Combination / therapeutic use
  • Biomarkers / blood
  • Creatine Kinase / blood*
  • Fluid Therapy / methods
  • Humans
  • Japan
  • Malaria / complications
  • Malaria / diagnosis*
  • Malaria / drug therapy
  • Malaria / parasitology
  • Male
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / parasitology
  • Muscle, Skeletal / pathology
  • Philippines
  • Plasmodium knowlesi / drug effects
  • Plasmodium knowlesi / genetics
  • Plasmodium knowlesi / isolation & purification*
  • Plasmodium knowlesi / pathogenicity
  • Polymerase Chain Reaction
  • Rhabdomyolysis / complications
  • Rhabdomyolysis / diagnosis*
  • Rhabdomyolysis / drug therapy
  • Rhabdomyolysis / parasitology
  • Thrombocytopenia / complications
  • Thrombocytopenia / diagnosis*
  • Thrombocytopenia / drug therapy
  • Thrombocytopenia / parasitology
  • Travel

Substances

  • Antimalarials
  • Artemether, Lumefantrine Drug Combination
  • Biomarkers
  • Creatine Kinase