Complete Dialysis‐Free Recovery From Severe Malaria–Associated Acute Kidney Injury and Multiorgan Failure: A Case Report and Brief Literature Review

Abstract

ABSTRACT Severe malaria remains a major cause of acute kidney injury and multiorgan failure in endemic regions, often requiring renal replacement therapy. However, access to dialysis is limited in many resource‐constrained settings, making outcomes highly dependent on early diagnosis and effective antimalarial treatment. We report a 32‐year‐old man who presented with 5 days of fever, rigors, and myalgia, followed by the onset of oliguria and altered sensorium. Laboratory evaluation revealed high‐density Plasmodium falciparum parasitemia, acute kidney injury (serum creatinine ≥ 5 mg/dL), thrombocytopenia, anemia, and electrolyte abnormalities. Chest radiograph demonstrated bilateral alveolar infiltrates, and upper gastrointestinal endoscopy confirmed active gastrointestinal bleeding. The patient was diagnosed with complicated P.falciparum malaria. Owing to the unavailability of timely hemodialysis because of financial constraints, the patient was managed with intravenous artesunate as per national guidelines, mechanical ventilation support, and intensive supportive care, which focused on judicious fluid balance, correction of electrolyte abnormalities, blood transfusion, and close hemodynamic and biochemical monitoring in the intensive care unit. By Day 7 of hospitalization, parasitemia had cleared, renal function showed progressive recovery, and both hemorrhagic and neurological complications had resolved. The patient was successfully extubated and discharged with significant clinical improvement. At 1‐week follow‐up, renal and hematologic parameters had normalized, with no residual neurological or functional deficits. The case highlights that in resource‐limited settings without access to dialysis, early initiation of intravenous artesunate and meticulous supportive care may achieve complete recovery, even in severe malaria–associated acute kidney injury requiring an intensive dialysis.