Volume 99, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Skeletal muscle is known to be damaged by falciparum malaria via sequestration of infected erythrocytes. We present a case of rhabdomyolysis caused by infection. The patient had fever, myalgia, and muscle weakness 5 days after returning to Japan from Palawan, the Philippines. Blood test revealed thrombocytopenia and an elevated creatine kinase level. Although rhabdomyolysis resolved with fluid therapy, fever of 24-hour cycle continued and thrombocytopenia intensified. On day 7 of illness, Giemsa-stained thin blood smear revealed malaria parasites, with a parasite count of 2,380/μL, which were morphologically indistinguishable between and . Rapid diagnostic test showed a negative result. The pathogen was later confirmed to be by nested polymerase chain reaction (PCR). The patient was successfully treated with artemether/lumefantrine. This case suggests that knowlesi malaria might be able to cause skeletal muscle damage.


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  1. Davis TM, Pongponratan E, Supanaranond W, Pukrittayakamee S, Helliwell T, Holloway P, White NJ, , 1999. Skeletal muscle involvement in falciparum malaria: biochemical and ultrastructural study. Clin Infect Dis 29: 831835. [Google Scholar]
  2. Davis TM, Supanaranond W, Pukrittayakamee S, Holloway P, Chubb P, White NJ, , 2000. Progression of skeletal muscle damage during treatment of severe falciparum malaria. Acta Trop 76: 271276. [Google Scholar]
  3. Komaki-Yasuda K, Vincent JP, Nakatsu M, Kato Y, Ohmagari N, Kano S, , 2018. A novel PCR-based system for the detection of four species of human malaria parasites and Plasmodium knowlesi. PLoS One 13: e0191886. [Google Scholar]
  4. Singh B, Kim Sung L, Matusop A, Radhakrishnan A, Shamsul SS, Cox-Singh J, Thomas A Conway DJ, , 2004. A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Lancet 363: 10171024. [Google Scholar]
  5. Singh B, Daneshvar C, , 2013. Human infections and detection of Plasmodium knowlesi. Clin Microbiol Rev 26: 165184. [Google Scholar]
  6. Yerlikaya S, Campillo A, Gonzalez IJ, , 2018. A systematic review: performance of rapid diagnostic tests for the detection of Plasmodium knowlesi, Plasmodium malariae, and Plasmodium ovale monoinfections in human blood. J Infect Dis 218: 265276. [Google Scholar]
  7. Siqueira AM, Alexandre MA, Mourao MP, Santos VS, Nagahashi-Marie SK, Alecrim MG, Lacerda MV, , 2010. Severe rhabdomyolysis caused by Plasmodium vivax malaria in the Brazilian Amazon. Am J Trop Med Hyg 83: 271273. [Google Scholar]
  8. Garcia F, Cebrian M, Dgedge M, Casademont J, Bedini JL, Neves O, Filella X, Cinta Cid M, Corachan M, Grau JM, , 1999. Endothelial cell activation in muscle biopsy samples is related to clinical severity in human cerebral malaria. J Infect Dis 179: 475483. [Google Scholar]
  9. Berendt AR, Simmons DL, Tansey J, Newbold CI, Marsh K, , 1989. Intercellular adhesion molecule-1 is an endothelial cell adhesion receptor for Plasmodium falciparum. Nature 341: 5759. [Google Scholar]
  10. Ockenhouse CF, Tegoshi T, Maeno Y, Benjamin C, Ho M, Kan KE, Thway Y, Win K, Aikawa M, Lobb RR, , 1992. Human vascular endothelial cell adhesion receptors for Plasmodium falciparum-infected erythrocytes: roles for endothelial leukocyte adhesion molecule 1 and vascular cell adhesion molecule 1. J Exp Med 176: 11831189. [Google Scholar]
  11. Yeo TW, Lampah DA, Kenangalem E, Tjitra E, Price RN, Anstey NM, , 2013. Impaired skeletal muscle microvascular function and increased skeletal muscle oxygen consumption in severe falciparum malaria. J Infect Dis 207: 528536. [Google Scholar]
  12. Marrelli MT, Brotto M, , 2016. The effect of malaria and anti-malarial drugs on skeletal and cardiac muscles. Malar J 15: 524. [Google Scholar]
  13. Shearer FM, 2016. Estimating geographical variation in the risk of zoonotic Plasmodium knowlesi infection in countries eliminating malaria. PLoS Negl Trop Dis 10: e0004915. [Google Scholar]
  14. Cox-Singh J, 2010. Severe malaria—a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report. Malar J 9: 10. [Google Scholar]
  15. Fatih FA, Siner A, Ahmed A, Woon LC, Craig AG, Singh B, Krishna S, Cox-Singh J, , 2012. Cytoadherence and virulence—the case of Plasmodium knowlesi malaria. Malar J 11: 33. [Google Scholar]

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  • Received : 23 Apr 2018
  • Accepted : 13 Jul 2018
  • Published online : 04 Sep 2018

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