Methods: A retrospective study was conducted using the data of all patients hospitalized for TS and BS in the infectious diseases department between 1991 and 2018. Results: Among a total of 117 patients, 73 had TS (62.4%) and 44 had BS (37.6%). Females were significantly more affected with TS than males (56.2% vs. 22.7%, p<0.001). Fever (72.7% vs. 45.2%, p=0.004) and sweating (72.7% vs. 47.9%, p=0.009) were significantly more frequent among patients with BS. The median erythrocyte sedimentation rate was significantly higher in the TS group (median, 70 mm/hr; interquartile range [IQR], 45–103 mm/hr) than in the BS group (median, 50 mm/hr; IQR, 16–75 mm/hr) (p=0.003). Thoracic involvement was significantly more frequent in the TS group (53.4% vs. 34.1%, p=0.04), whereas lumbar involvement was significantly more frequent in the BS group (72.7% vs. 49.3%, p=0.01). Initial imaging findings revealed significantly higher frequencies of posterior vertebral arch involvement, vertebral compaction, and spinal cord compression in the TS group. Percutaneous abscess drainage (20.5% vs. 2.3%, p=0.005) and surgical treatment (17.8% vs. 2.3%, p=0.01) were more frequently indicated in the TS group, with a significant difference. Conclusions A combination of clinical, laboratory, and radiological features can be used to distinguish between TS and BS while these patients await diagnosis confirmation.

Rationale: Haemophagocytic lymphohistiocytosis is a rare complication of malaria, which is often misdiagnosed. Patient concerns: A 30-year-old male was admitted to our department for persistent fever, which began after returning from a stay in Guinea-Conakry. The laboratory investigations revealed a pancytopenia and an elevated C-reactive protein. Peripheral smear examination showed Plasmodium falciparum, therefore confirming the diagnosis of malaria. The laboratory tests showed a worsening pancytopenia. Bone marrow aspiration and biopsy revealed images of hemophagocytosis. Diagnosis: The diagnosis of haemophagocytic lymphohistiocytosis complicating malaria infection was established. Interventions: The patient was treated with artemether-lumefantrine. No immunosuppressant treatment was delivered to the patient. He received antipyretic and antimalarial treatment only. Outcomes and lessons: We report a case of haemophagocytic lymphohistiocytosis trigged by malaria infection and we review all reported cases secondary to Plasmodium falciparum malaria by searching PubMed publications till October 2019. Haemophagocytic lymphohistiocytos secondary to malaria should be suspected even in non-severe cases of malaria. Hammami Fatma 1 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Koubaa Makram 2 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Chaari Mourad 3 Hematology Laboratory, Hedi Chaker University Hospital, University of Sfax Chaabouni Rim 4 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Zeyni Abrakhom 5 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Rekik Khaoula 6 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Smaoui Fatma 7 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Jemaa Mounir 8 Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax Nascimento TL do, Vasconcelos SP, Peres Y, Oliveira MJS de, Taminato M, Souza KMJ de. Prevalence of malaria relapse: Systematic review with meta-analysis. Rev Lat Am Enfermagem 2019; 18(27): e3111. 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