Diffuse alveolar hemorrhage due to Plasmodium falciparum: a rare entity--are steroids indicated?

Severe falciparum malaria is common in tropics, patients usually present with any of the following manifestations or combination of cerebral manifestations, circulatory failure, liver failure, acute lung injury and acute kidney injury. Pulmonary manifestations in falciparum malaria usually include acute respiratory distress syndrome (ARDS) and acute lung injury (ALI)1. Here, we present two cases of Plasmodium falciparum malaria manifesting as diffuse alveolar hemorrhage (DAH). The reports on DAH are scarce. The use of steroids improved DAH in both the cases. Mechanism of diffuse alveolar hemorrhage in falciparum malaria is still not clear, and further research is needed regarding the pathophysiology and therapeutic intervention. This case report emphasizes on future research.