Case Studies
Case Studies
Case Studies
Case 1
• A 26 years old man was referred from peripheral hospital
with dengue haemorhagic fever (DHF) grade I with
unconsciousness of unknown cause.
• The history before admission: he had 3 day fever, Vital signs
and physical examination was normal.
• Laboratory results: platelets 42,000/mm3, hematocrit 43,3
%. Malaria smear negative. Serology anti dengue IgM
positive, IgG negative.
• On the second day platelets decreased to 18,000 and
hematocrit 30,3%.
• On day 4 his general condition was getting worse,
consciousness was further decreased. He was referred to
the district hospital for further care.
Question 1
What was the likely differential diagnosis?
Case 2
• Male, 57 years old, admitted to hospital with fever for 7 days, chills
and sweating. He also had nausea, vomiting and headache. His skin
looked yellowish since 2 days before admission. His urine is dark
coloured.
Question 2
• What antimalarial drug should be given in this
patient?
Question 3
• Any comments on the low platelets count?
What it means to have gametocytes in the
peripheral blood? What is the management?
Case 6
• A baby boy aged 6 months old admitted to the
hospital with rapid breathing since 2 days before
admission. He also had fever for 5 days. The boy
was unable to beastfed and looked pale.
Question 2
• How is the blood glucose level? How is the
level of parasitaemia? What is your
assessment?
Question 3
• What is the management of this patient? Does
this patient need fluid restriction?
Case 7
• Location: Zero malaria transmission area, city area.
• On the next day he felt extremely weak and unable to stand up and
his urine become darker. He was taken to the hospital and was
diagnosed as sepsis. He was treated with antibiotics and other
supportive treatment and admitted to ICU.
• On day 5 of hospitalization, the patient was checked for
malaria and the result is positive falciparum malaria.
The patient was treated with intravenous artesunate
accordingly but the condition was getting worse and he
died on day 6 of hospitalization.
Question 2
• What should be the diagnosis of this patient?
Question 3
• What antimalarial drug should be given in this
patient? What is the management of AKI in
this patient?
Case 8
6th September 2014.
• Male, 15 years old was referred from local
hospital after 10 days of hospitalization and 3
days of ICU care due to severe falciparum
malaria with acute kidney injury. Body weight:
43 kg.
History of hospitalization in referring hospital:
25th August 2014
Question 2
What is the likely cause of malaria positive on
2nd October 2014? What is your comment?
Case 9
• A girl, 1 year old came to the hospital with convulsion
about 10 minutes before admission. She had fever one day
before admission. She was unconscious when admitted.
Vital signs: Somnolent, HR 140 x/min, RR 30 x/min, body
temp 39.80C, BW 8.5 kg, SpO2 98% in room air. Physical
examinations were within normal limit.
Question 2
• What is your comment on the parasitaemia in
this patient? What is the clinical significance
Pf schizont and Pf gamet in the peripheral
blood?
Question 2
• What is the best way to count parasitaemia in
this case?
Question 3
• What is your comment on the treatment and
the reduction rate of parasitaemia?
Case 11
• Male, 31 years old, works as a miners at Halmahera (Gosowo)
admitted to hospital on 31st October 2009 with a complaint of
fever and colds since 4 days before hospitalization. Five days
before admission he felt diarrhea once.
Question 2
• What treatment should be given to this
patient?
Case 12
• Female 51 years old admitted to hospital with
diarrhea for 5 days, nauseated and yellow eyes
for 1 day before admission. Six days before
admission, she had experience of headache,
nausea, vomiting and she had self medication
with paracetamol.
• Laboratory findings:
– Hb. 7.1 gr%, Leucocyte 7900 cells/mm3,
differential leucocyte (eos/ baso/neut/ lim/mon)
3/0/83/11/3, malaria falciparum ring +++, parasite
count 7.4 %, total bilirubine 8.2 mg/dL, direct
bilirubin 3.1mg/dL, SGOT 75 u/L, SGPT 54 u/L,
random blood sugar 84 mg/dL, Ureum 128 mg/dL,
Creatinin 2.89 mg/dL.
Question 2
• What is the diagnosis of this patient?
Question 3
• Discuss the clinical presentation, microscopy
results, differential diagnosis and case
management of this patient.
Case 13
Women 55 years, history of 5 day fever, lived in
malaria endemic area, referred to our hospital
by A & E doctor with GCS of 6.
Question 2
• What are your managements?
• What is your differential diagnosis?
• After 2 hours in the ward, laboratory result
was reported as Hb. 9 gr%, Leucocyte 21.000/
mm3, differential leucocyte : eos 3/ bas 1/
neutrofil 80/ limfo 15/ mono 1, platelet
40,000/mm3. Random blood sugar 25 mg%.
Parasite count: 3,500 parasite/200 WBC, 88
parasite/1000 RBC.
Question 3
• What is your diagnosis and management?
Case 14
• A man 47 years old came to hospital with fever for 3 days,
the patient arrived in Jakarta from island where malaria
transmission might occur. Patient complaint of nauseated,
vomiting, cough and rhinitis.
Question 2
• What is your diagnosis? What is your
management?
• The patient was treated by dopamine drip,
intravenous dexamethasone 2 amp/6 hours,
urine catheter was inserted, IVFD with Normal
Saline and Ringer Lactate.
Question 3
• What is your comment on the above
management?
• On day 4, he vomited coffee ground colors
about 100 cc, blood pressure 100/50 mmHg,
temp 39.5C. Widal test negative, Lipase 65
u/L, amilase 87.6 u/L. USG abdomen reported
as Pankreatitis & Cystitis
Question 4
• What is your diagnosis?
Blood Gas analysis results
Question 5
• What is your diagnosis?
• On day 5 general condition was getting worse ,
he became somnolent, stupor, and convulsion.
• Respiratory arrest occurred, he was put on
ventilator. Blood pressure 110/70 mmHg,
pulse 120/min, temp 390C, urine 250 cc/day.
Ureum 209 mg%, Creat 5.9 mg%, K 5.3 meq/L.
Question 5
• What is your diagnosis?
On late evening day 5: the laboratory results
finally showed malaria falciparum ++++, with
trophozoite form appeared. The patient was
rescued with anti malaria treatment but patient
died subsequently.