Spontaneous Hemoperitoneum in a case of Plasmodium vivax Malaria without Splenic Rupture.

Vivax malaria is usually a benign infection but now trends are changing. We, here present an unusual case of P. vivax malaria presenting with spontaneous hemoperitoneum with thrombocytopenia. Spontaneous hemoperitoneum in P. vivax malaria has been reported earlier but with splenic rupture. However our case though had hemoperitoneum but no splenic rupture. In our case, thrombocytopenia was found to be the cause of hemoperitoneum which has not been reported earlier in Indian literature.

Spontaneous splenic rupture presenting as haemoperitoneum: coinfection of Plasmodium vivax and Plasmodium falciparum.

Non-traumatic splenic rupture has been described in the medical literature as a clinical entity with grave consequences, if diagnosis and subsequent treatment are delayed. Various pathological reasons implicated in non-traumatic spontaneous splenic rupture have been described in literature ranging from infection, malignancy, metabolic disorders as well as haematological malignancies. This case reports a 30-year-old man who presented in the emergency department with complaints of fever and a sudden-onset abdominal pain with no history of trauma. At hospital admission, abdominal tenderness with splenomegaly was present with free fluid in abdomen. Haematological investigations established the coinfection of Plasmodium falciparum and Plasmodium vivax. Radiological investigations revealed splenic laceration with moderate haemoperitoneum. The patient was managed conservatively with strict vital monitoring. Later on, elective splenectomy was performed. The authors report only the second case in literature with coinfection of plasmodium species presenting with haemoperitoneum.

Hepatosplenic schistosomiasis presenting as spontaneous hemoperitoneum in a Filipino immigrant.

Hepatosplenic schistosomiasis is due to chronic parasitic trematode infections with various Schistosoma sp. The Schistosoma life cycle requires contamination of surface water by infected human or animal excreta, specific freshwater snail intermediate hosts and human skin contact with water. The disease is prevalent in many developing tropical areas, particularly in sub-Saharan Africa as well as in Southeast Asia. Deposition of Schistosoma eggs in the hepatic portal system leads to periportal fibrosis, cirrhosis and portal hypertension but little hepatocellular damage. Portal hypertension of any etiology may cause gastrointestinal varices. Rarely, ectopic varices may rupture into the peritoneal cavity and result in a hemoperitoneum. The authors describe a case of a Filipino immigrant who presented with a hemoperitoneum associated with previously unrecognized hepatosplenic schistosomiasis due to Schistosoma japonicum.