I agree with Imbert et al. that when left upper quadrant abdominal pain occurs during an acute malaria attack, the attending physician should search not only for splenic infarction but also for splenic rupture. Although splenomegaly is frequently observed in malaria cases, pathological rupture of the spleen is not as commonly observed clinically, probably because splenomegaly in malaria is not soft and friable but firm. One of the mechanisms of splenic rupture is thought to be splenic infarction. Various pathological changes, including thrombi in arte-rioles, veins and sinusoid, have been described in the malarial spleen that can lead to infarction. The true incidence rate of splenic infarction can easily be underestimated as splenomegaly tends not to receive special attention in cases of malaria. The actual incidence rate of splenic infarction can be determined if ultrasound or computed tomography is performed more frequently in malaria cases.
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