Supplementary Material for: Malaria as Potential Etiology and Treatment Complicating Factor in DLBCL Patient: a Case Report

Malaria is known to be a significant risk factor and also a potential complicating factor during the treatment of lymphoid malignancy. There has not been a reported case of malaria reactivation that occurred weeks after cytotoxic chemotherapy completion, especially in non-endemic regions. Our patient was a 47-year-old man with a history of repeated falciparum malaria infection experiencing two months of progressive unilateral nasal blockage and recurrent anterior epistaxis, which was diagnosed as diffuse large B-cell lymphoma (DLBCL) through pathological examination. He was treated with six cycles of classical R-CHOP, resulting in complete remission. One month after remission, he experienced shivering, fever, sweating, and a return to normal temperature, which repeated irregularly for roughly one week. His laboratory result showed anemia, leukopenia and profound thrombocytopenia. Immunochromatographic testing (ICT) confirmed the diagnosis of falciparum malaria. This case was considered a relapse since our centre is not in the malaria-endemic region. He was cured with a combination of dihydroartemisinin-piperaquine and primaquine. Our case demonstrated the duality of malaria as potential etiology and treatment complicating factor in DLBCL.

疟疾已被证实为淋巴恶性肿瘤治疗过程中的重要风险因素与潜在并发症诱因。目前尚无细胞毒性化疗结束数周后出现疟疾复燃的病例报道，尤其在非疟疾流行区。本次病例为一名47岁男性，既往有反复恶性疟原虫感染病史，因2个月来出现进行性单侧鼻塞、反复前鼻出血就诊，经病理检查确诊为弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma, DLBCL）。患者接受6周期标准R-CHOP方案治疗后达到完全缓解。缓解后1个月，患者出现寒战、发热、大汗伴体温恢复正常的症状，上述症状不规则反复发作约1周。实验室检查结果显示贫血、白细胞减少症及重度血小板减少症。免疫层析试验（immunochromatographic testing, ICT）确诊为恶性疟原虫感染。鉴于本中心所在地区并非疟疾流行区，本次病例被判定为疟疾复发。患者经双氢青蒿素哌喹与伯氨喹联合治疗后痊愈。本病例证实了疟疾在弥漫性大B细胞淋巴瘤诊疗中兼具潜在病因与并发症诱因的双重特性。