摘要：massive splenomegaly with no abscess,collctionor lymphadenopathy. Her upper gi endoscopy was normal. During her course in hospital she was managed with parenteral artesunate for five days with oral mefloquine,doxycycline,primaquine and subsequently with oral artemether and lumefantrine along with combination of broad spectrum antibiotics. She also received 6 units of blood components. Despite these even on10th day her peripheral smear remained positive for Plasmodium vivax,requiring continuation of parenteral artesunate and became negative only after 14 days of artesunate therapy. Patient was given a total 3 weeks of artesunate therapy with other supportive therapy. A final diagnosis of mixed complicated resistant malarial infection with hyper reactive splenomegaly was made. She was subsequently discharged and presently under followup.
