Case 129. Malaria, malignant (cerebral) (60 y-o M)
    Japanese photographer who traveled in Kenya, presenting high fever, jaundice and consciouness disturbance    
Key words : Plasmodium falciparum, cerebral malaria, ring form
Frontal section of the formalin-fixed brain reveals multiple hemorrhagic spots in the basal ganglia and white matter. The brain tends to be brown-colored (gross findings).   Microglial growth results in the formation of small perivascular granulomas. Perivascular hemorrhage and edema are associated (HE).
Congested capillary vessels show stasis of red cells deposited with coarse malaria pigment (HE).   The red cell infected with a trophozoite of Plasmodium falciparum reveals formation of multiple "knobs" on the surface (Electron micrograph). The infected red cell adheres to the endothelial cell via adhesion molecules specifically expressed on the knobs. This explains the reason why the red cells with trophozoites of P. falciparum do not appear in the peripheral blood.