CASE REPORT Journal of Evolution of Medical and Dental Sciences/Volume 1/Issue 6/December-2012 Page-929 RETINAL HAEMORRHAGE IN PLASMODIUM VIVAX PATIENTS- 2 RARE CASE REPORTS Sangeeta Sharma, Ujwala Maheshwari, Nidhi Bansal 1. Assistant Professor, Department of Pathology MGM Medical College, Navi Mumbai 2. Professor, Department of Pathology MGM Medical College, Navi Mumbai 3. Resident, Department of Pathology MGM Medical College, Navi Mumbai CORRESPONDING AUTHOR Dr. Sangeeta Sharma, 1801, Kasturi Heights, Sector-20, Plot 39, Kharghar, Navi Mumbai, Maharashtra, India E-mail: drsangeetasharma@gmail.com Ph: 0091 9323009867, 0091 8692999076 ABSTRACT: Retinal haemorrhage is commonly detected during ophthalmoscopic examination of patients with Plasmodium falciparum infections. However, it is observed very rarely in Plasmodium vivax infections. Only six cases of retinal haemorrhage have been reported so far in Plasmodium vivax infections. We review the literature and discuss two such cases of retinal haemorrhage that presented at our hospital. It is suggested that retinal haemorrhage be routinely ruled out in all malaria patients, and Plasmodium vivax infection be considered in patients with unexplained retinal haemorrhage and fever. KEYWORDS: Retinal Haemorrhage, Plasmodium vivax, Plasmodium falciparum, Malarial Retinopathy CASE REPORT 1: A 23 year old female presented with complaints of fever with chills, malaise since 5 days, and a few episodes of watery, non-blood stained vomiting. There was no history of any bleeding manifestations, joint pain, or breathlessness. She had no significant past history. Clinical examination revealed Fever-100°F, Pulse rate-130/min regular, Blood pressure-110/70 mm Hg, severe pallor, and mild icterus. Systemic examination per abdomen revealed soft, mild hepato-splenomegaly. Routine lab investigations showed Hb-2.4gm%, low Platelet count- 20,000/cumm, Total Bilirubin-4.74mg/dl and Serum Creatinine-1.34mg/dl. Peripheral smear showed pancytopenia with microcytic hypochromic anemia and ring forms of trophozoites and schizonts of Plasmodium vivax. Anti-malarial treatment was started and blood transfusion was also done. On the morning of Day 3, the patient suddenly developed blurring of vision. An urgent ophthalmoscopic examination revealed generalized retinal bleeding involving the macular areas in both eyes (Right eye>Left Eye), leading to the loss of vision [Fig 1]. A review ophthalmoscopic examination done 5 days later showed that both eyes had Sub-hyaloid haemorrhages along with Roth’s spots. CASE REPORT 2: A 23 year old male presented with complaints of malaise, fever with chills off and on for 5 days, bleeding per rectum since 3 days, and blurring of vision since 3 days. There was no history of bleeding from any other site or any rashes or joint pain. Clinical examination showed that he was afebrile, Pulse rate-88/min regular, Blood pressure-110/70 mm Hg, severe pallor, icterus, and bilateral pitting pedal edema. Systemic examination showed mild hepato-