Case presentation:
A 49- year-old female presented to a hospital in Khartoum state, central
Sudan with slurred speech, tremors affecting her upper limbs, and a
sense of imbalance and dizziness while walking which lasted for five
days. Twelve days prior, she reported a 3-day history of fever with
chills for which she took paracetamol tabs 500 mg four time per day. The
patient had no history of a rash, common cold, nor headache as well as
no neck pain, sensory or motor deficit. Also, she has no history of
bulbar symptoms, vomiting, recent vaccination, or alcohol abuse as well
as no smoking, joint pains, or fluctuation in body weight. Before
admission, she was not diagnosed with malaria, nor did she receive any
antimalarial therapy.
On the clinical examination, the patient was conscious and oriented to
time, place and person. She had a normal pulse rate (76/min),
respiratory rate (17/min), blood pressure (90/50), and temperature
(39°C). Neurological examination showed no evidence of meningism.
However, the patient had an ataxic gait, dysarthria, tremor of the upper
limbs, dysdiadochokinesia, and hypotonia, but no bradykinesia, rigidity
and nystagmus. Furthermore, she had normal sensation. Magnetic resonance
imaging (MRI) of the brain was done in order to rule out the possibility
of post-infectious cerebellitis and it showed normal brain structures;
ventricular system; no evidence of haemorrhage or infarct and no midline
shift. An electroencephalogram was done and was normal.
A blood sample was collected from the patient and sent to the laboratory
for routine investigations. Further investigations revealed microcytic
hypochromic anaemia and confirmed the presence of Plasmodium
falciparum gametocytes in the peripheral blood smear. Viral screening
for Epstein-Barr virus (EBV), Cytomegalovirus (CMV), major endemic
arboviruses, human immunodeficiency (HIV) and Hepatitis viruses were
negative. Liver function test revealed a serum bilirubin 0.7 mg/dl,
total protein 7.6 g/dl, serum albumin 5.8 g/dl, alkaline phosphatase 79
U/l, aspartate aminotransferase (AST) 21 U/L, and alanine
aminotransferase (ALT) 26 U/l. Renal functional test showed a normal
value of urea in blood (27 mg/dL) and serum creatinine (0.71 mg/dL).
Complete blood count examination showed leucocytosis (12.3
x103), haemoglobin 11.0 g/dl and platelets count
149x103. A sputum sample was collected and was
negative for acid-fast bacilli.
The patient received artemether/lumefantrine four tablets (20 mg
artemether; 120 mg lumefantrine per tablet) orally (PO) as an initial
dose, followed by four tablets P.O. 8 hours later, then four tablets
P.O. twice daily (morning and evening) for two days for a total course
of 24 tablets. She responded well after three days. The patient was
discharged 21 days after admission. She has recovered and regained a
normal health status.