Case Report: Plasmodium knowlesi Infection with Rhabdomyolysis in a Japanese Traveler to Palawan, the Philippines

Saho Takaya Diseases Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;

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Satoshi Kutsuna Diseases Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;

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Tetsuya Suzuki Diseases Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;

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Kanako Komaki-Yasuda Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine Research Institute, Tokyo, Japan

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Shigeyuki Kano Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine Research Institute, Tokyo, Japan

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Norio Ohmagari Diseases Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;

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Skeletal muscle is known to be damaged by falciparum malaria via sequestration of infected erythrocytes. We present a case of rhabdomyolysis caused by Plasmodium knowlesi 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 P. knowlesi and Plasmodium malariae. Rapid diagnostic test showed a negative result. The pathogen was later confirmed to be P. knowlesi 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.

Author Notes

Address correspondence to Satoshi Kutsuna, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan. E-mail: sonare.since1192@gmail.com

Authors’ addresses: Saho Takaya, Satoshi Kutsuna, Tetsuya Suzuki, and Norio Ohmagari, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan, E-mails: takayasaho@gmail.com, sonare.since1192@gmail.com, tesuzuki@hosp.ncgm.go.jp, and nohmagari@hosp.ncgm.go.jp. Kanako Komaki-Yasuda, Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine Research Institute, Tokyo, Japan, E-mail: komaki@ri.ncgm.go.jp. Shigeyuki Kano, National Center for Global Health and Medicine Research Institute, Tokyo, Japan, E-mail: kano@ri.ncgm.go.jp.

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