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Korean J Parasitol > Volume 57(4):2019 > Article
The Korean Journal of Parasitology 2019;57(4):405-409. doi: https://doi.org/10.3347/kjp.2019.57.4.405
Subcapsular Splenic Hemorrhage in Vivax Malaria
Jae Hyoung Im1, Moon-Hyun Chung2, Areum Durey3, Jin-Soo Lee1, Tong-Soo Kim4, Hea Yoon Kwon1, Ji Hyeon Baek1
1Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
2Department of Internal Medicine, Seogwipo Medical Center, Jeju 63585, Korea
3Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
4Department of Tropical Medicine, Inha University School of Medicine, Incheon 22332, Korea
* Corresponding Author: Ji Hyeon Baek, 
Received: April 27, 2019;  Revised: July 19, 2019;  Accepted: August 5, 2019.
Abstract
In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.
Key words: Plasmodium vivax, hemorrhage, malaria, spleen, splenic rupture
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