Case Report: A Case of Bone Marrow Necrosis and Hyperinflammation in a 10-Year-Old Boy after Plasmodium falciparum Infection

Caitlyn Hui Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Canada;
Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;

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Alessandra Bosch Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
The Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada;

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Oscar Mwizerwa Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada;

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Jeanine McColl Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada;

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Antoine Corbeil Microbiology and Laboratory Science, Public Health Ontario, Toronto, Canada;

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Caroline Malcolmson Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
The Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada;

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Deborah M. Levy Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada;

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Zia Bismilla Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;
Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada

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Shaun K. Morris Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Canada;
Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada;

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ABSTRACT.

A 10-year-old boy with sickle cell disease (SCD) type SC presented with fever and abdominal pain after travel to Ghana and was diagnosed with Plasmodium falciparum infection. Despite adequate antimalarial treatment, he developed evidence of hyperinflammation with marked elevated ferritin, C-reactive protein, and triglycerides and subsequent bone marrow necrosis, characterized by elevated nucleated red blood cells and significant bone pain. This case report highlights the possible association between malaria and bone marrow necrosis in patients with SCD. Important considerations in treatment and workup of patients presenting with malaria and hyperinflammation are discussed.

Author Notes

Address correspondence to Shaun K. Morris, Division of Pediatric Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada. E-mail: shaun.morris@sickkids.ca

Authors’ addresses: Caitlyn Hui and Shaun K. Morris, Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Canada, and Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada, E-mails: caitlyn.hui@sickkids.ca and shaun.morris@sickkids.ca. Alessandra Bosch and Caroline Malcolmson, Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada, and The Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada, E-mails: alessandra.bosch@sickkids.ca and caroline.malcolmson@sickkids.ca. Oscar Mwirzera, Jeanine McColl, and Deborah M. Levy, Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada, and Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada, E-mails: oscar.mwirzera@sickkids.ca, jeanine.mccoll@albertahealthservices.ca, and deborah.levy@sickkids.ca. Antoine Corbeil, Microbiology and Laboratory Science, Public Health Ontario, Toronto, Canada, E-mail: antoine.corbeil@oahpp.ca. Zia Bismilla, Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada, and Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada, E-mail: zia.bismilla@sickkids.ca.

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