Successful Non-operative Management of Spontaneous Splenic Rupture with Hemoperitoneum in Plasmodium vivax Malaria: A Case Report from Central India

Abstract

Background: Plasmodium vivax malaria, traditionally considered benign, is now increasingly recognized as a cause of severe and life-threatening complications. Among these, spontaneous splenic rupture (SSR) is a rare but critical emergency associated with significant morbidity and potential mortality if not promptly managed. Aims: To report a case of spontaneous splenic rupture (SSR) secondary to Plasmodium vivax malaria managed successfully with Non-Operative Management (NOM), and to highlight the viability of splenic salvage in hemodynamically responsive patients. Presentation of Case: A 28-year-old male from Central India presented with a 6-day history of high-grade fever, chills, and acute left upper quadrant abdominal pain. Clinical examination revealed hypotension (80/60 mmHg), tachycardia (110 bpm), pallor, and icterus. Diagnostic evaluation confirmed P. vivax mono-infection. CECT abdomen revealed massive splenomegaly with subcapsular hematomas and hemoperitoneum. The patient showed rapid physiological response to crystalloid resuscitation, permitting a trial of NOM. Discussion: The patient was managed conservatively in the ICU with intravenous artesunate followed by oral primaquine. Hemodynamic stability was maintained without blood transfusions despite a hemoglobin nadir of 8.0 g/dL. Following 12 days of strict monitoring, the patient was discharged with complete clinical recovery and radiological resolution confirmed at 6-week follow-up. Conclusion: This case demonstrates that P. vivax malaria can cause spontaneous splenic rupture even in the absence of trauma. Hemodynamically unstable patients who respond well to initial fluid resuscitation can be successfully managed conservatively, preserving immunological function and avoiding the morbidity of splenectomy.