Acute renal failure from myoglobinuria secondary to myositis from severe falciparum malaria

Renal disease is a common complication in malaria infection, In acute falci parum malaria renal involvement is usually mild, but in severe disease acut e renal failure is a major problem, Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatat ion due to endothelial injury, Though myositis is recorded as a common mani festation in falciparum malaria, only 1 case with myositis and myoglobinuri a with acute renal failure has been documented; but no renal biopsy was per formed in the patient, In the present study we examined the case of a 17-ye ar-old man with severe falciparum malaria with myositis and myoglobinuria w ho developed acute renal failure requiring dialysis, Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells, T he kidney biopsy showed scanty T cells and macrophages in the glomeruli whi ch were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrop hages and T lymphocytes but no CD4+ cells, Rhabdomyolysis induced by macrop hages and T cells with myoglobinuria and acute renal failure is a problem i n severe falciparum malaria infection, Copyright (C) 2000 S. Karger AG. Bas el.