Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis

Table 1

Laboratory findings.

	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 10	Reference range
Parasitemia %	1%	9%	7.6%	3%	0.5%	None	None	None	None
Medication		Q + D	Artesunate		Artemether/lumefantrine
Creatinine	1.02	0.98	3.34	5.43	7.05	8.71	8.66	8.80	0.60–1.30 mg/dL
Hemoglobin	13.4	12.4	10.9	10.2	10	9.3	8.7	8.8	14.0–17.5 g/dL
WBC	6.0	2.5	4.7	7.0	8.7	10.1	11.3	7.2	4.8–10.8 × 10^3/μL
Platelet	41	22	18	28	50	58	108	462	130–300 × 10^3/μL
Haptoglobin	NA	<30	<30	NA	NA	NA	NA	<30	44–215 mg/dL
LD	NA	525	1664	1005	974	577	503	523	140–271 IU/L
Total bilirubin	8.4	7.5	18.6	9.3	8.1	3.7	2.4	1.9	0.3–1.0 mg/dL
Direct bilirubin	3.9	3.6	14	5.7	4.8	2.3	1.4	0.8	0.0–0.2 mg/dL
AST	103	121	314	172	201	106	94	55	13–39 IU/L
ALT	56	59	73	68	81	57	47	60	7–52 IU/L
D dimer	NA	>20	>20	17.33	11.70	3.26	1.68	NA	<0.50 μg/mL
Fibrinogen	NA	375	415	428	428	399	385	NA	222–525 mg/dL
Fibrin split products	NA	>40	>40	NA	10–40	10–40	10–40	NA	<10 μg/mL
Prothrombin time	NA	18.0	17.6	14.3	13.2	14.1	13.8	NA	11.7–14.2 seconds
INR	NA	1.6	1.5	1.1	1.0	1.1	1.1	NA	0.9–1.1
PTT	NA	40.5	38.3	31.2	29.3	30.2	30.3	NA	23.1–34.3 seconds
Lactic acid	NA	6.3	4.6	NA	NA	NA	NA	NA	0.6–1.4 mmol/L

LD: lactate dehydrogenase, AST: aspartate transaminase, ALT: alanine transferase, PTT: partial thromboplastin, : atovaquone proguanil, Q + D: quinine + doxycycline.