Pulmonary edema, a rare but catastrophic complication of acute falciparum malaria, was rapidly fatal in the two patients reported. Air-hunger and cyanosis were early features of the illness, appearing before physical and roentgenographic evidence of pulmonary edema. Even though antimalarial therapy cleared the parasitemia, the pulmonary edema progressed relentlessly despite vigorous therapy. Circulatory overload did not cause the pulmonary edema, as determined by body weight, venous pressure, and fluid balance. Nor were pneumonia or cardiac disease found. The origin of the pulmonary edema was equally obscure in six previously reported cases. The basic lesion appears to be injury to the capillaries of the lung, which does not require the continued presence of the parasite for its perpetuation. Direct damage to the capillaries by Plasmodium falciparum cannot be excluded, but an allergic reaction to the infection, with the lung as the shock organ, is proposed to explain the phenomenon of pulmonary edema.
Formerly Captain, USAF, MC, member of the internal-medicine staff, 12th USAF Hospital, Cam Ranh Bay, Vietnam. Currently NIH Fellow in Immunohematology (USPHS Training Grant HE-05677).