Malignant malaria: autopsy findings and morphological features

Malignant malaria, resulting from Plasmodium falciparum infection transmitted by Anopheles mosquitoes, is a life-threatening emergency leading to high mortality rate in sub-Saharan Africa . P. falciparum infects red blood cells causing their aggregation and adhesion to the endothelial lining of small vessels. This microvascular sequestration can obstruct blood flow, leading to ischemia and perivascular hemorrhages caused by rupture of small vessels. In case of sudden death, diagnosis is possible only post-mortem by autopsy that play a crucial role in determining the accurate cause. Here, a case of cerebral malaria that resulted in death, detailing the relevant autopsy findings. A case of severe malaria in a 54 years old woman, with a history of untreated multiple myeloma, who travelled for business purpose in Central Africa without taking antimalarial chemoprophylaxis, is reported. She presented at the hospital with fever, headache and asthenia with rapid progression to multiorgan failure (MOF) leading to death on day four since hospitalization. As Plasmodium falciparum infection does not invariably lead to death, an autopsy was requested to determine the cause of death and to assess whether the infection was directly responsible or other factors were involved. This case highlights its iconographic importance, demonstrates scenarios relevant to pathologists, and underscores the need to always consider Plasmodium falciparum infection in the differential diagnosis of febrile travellers from malaria-endemic regions.