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Tropical Splenomegaly — RACP Adult Medicine MCQ

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HardInfectious DiseasesTropical SplenomegalyRACP Adult Medicine

A 25-year-old man from sub-Saharan Africa presents with massive splenomegaly (palpable 15 cm below costal margin), pancytopenia, and recurrent fevers. Blood film shows Plasmodium species. He has lived in a malaria-endemic area his entire life. IgM levels are markedly elevated. What is the most likely cause of splenomegaly?

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Correct answer: E — Tropical splenomegaly syndrome (hyperreactive malarial splenomegaly)

Massive splenomegaly with elevated IgM in a person from a malaria-endemic area with chronic Plasmodium exposure is tropical splenomegaly syndrome (hyperreactive malarial splenomegaly). It is an aberrant immune response to chronic malaria. Treatment is prolonged antimalarial prophylaxis (proguanil). Splenectomy may be needed for refractory cases.

Reference: eTG Antibiotic – 2025 – Malaria; WHO 2024