COINFECTION WITH PLASMODIUM VIVAX AND CHIKUNGUNYA; WHEN FEBRILE ILLNESS EVOLVES INTO HYPERDYNAMIC SHOCK: CASE REPORT

Coinfection with malaria and chikungunya is a rare presentation and poses a diagnostic challenge., especially since both infections can produce systemic manifestations and hemodynamic compromise. We present the case of a 23-year-old female patient from an urban area with no known past medical history, who presented with a seven-day history of fever, dizziness, generalized weakness, arthralgia, and vomiting. On admission, she was febrile, tachycardic, and hypotensive, with an insufficient hemodynamic response to initial resuscitation with crystalloids, requiring vasopressor support. Advanced cardiovascular evaluation revealed a predominantly vasodilatory and hyperdynamic profile, characterized by high cardiac output, decreased systemic vascular resistance, and preserved stroke volume. Left and right ventricular systolic and diastolic function remained preserved, with adequate TAPSE and MAPSE, and no significant chamber dilation or regional contractility abnormalities. The electrocardiogram and cardiac enzymes showed no evidence of myocardial injury or myocarditis. Studies revealed severe anemia, with a hemoglobin level of 6 g/ dL, and hepatosplenomegaly. Thick blood smear identified Plasmodium. The patient tested positive for vivax, while the PCR test for chikungunya was positive and the dengue test was negative, confirming the coinfection. Intravenous artesunate was initiated, followed by artemether-lumefantrine, in addition to vasoactive support and transfusion of two units of packed red blood cells. The patient experienced progressive hemodynamic recovery and a favorable clinical course. This case highlights the importance of considering vector-borne coinfections and characterizing the hemodynamic phenotype to differentiate vasodilatory shock from cardiogenic compromise.