Chronic Splenomegaly in a 10-Year-Old Boy

Rebecca Winderman, MD; Natalie Banniettis, MD; Simon S. Rabinowitz, MD, PhD


April 23, 2018

Treatment regimens for HMS differ by region. If the patient resides in an endemic country with a risk for recurring exposures to Anopheles mosquitoes, chronic treatment is recommended. Although multiple sources recommend chronic antimalarial therapy, in nonendemic countries, a short course (≤1 week) of treatment (chloroquine, atovaquone-proguanil, pyrimethamine-sulfadoxine) is likely sufficient because the risk for re-exposure is low. Splenectomy should be reserved for patients with huge splenomegaly, those with disabling symptoms, or patients who do not respond to medical therapy.

The patient in this case was treated with atovaquone-proguanil for 3 days, as per recommendations from the Centers for Disease Control and Prevention. Clinical improvement was noted on examination findings within 2 months of therapy, by which point the patient was no longer complaining of abdominal pain. The spleen had become barely palpable, and the patient was eating better and gaining weight.


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