• Malaria diagnosed in Africa for which he was treated with Artequin in May 2004
• Skin rash on the leg complicating Artequin therapy

Patient presented to ER with 10 day history of:

• Increasing shortness of breath which has much worsened over the past 24 hours
• Dry cough, no expectoration and no hemoptysis
• Generalized weakness and fatigue
• No chest pain but left upper quadrant abdominal pain which is constant and dull in nature
• No fever and no chills but nocturnal sweats

The patient denies any history of IV drug abuse.  He says that in his whole lifetime he has had only two sexual partners.  His current fiancee who is in Africa works as a nurse in a hospital.  No other risk factors documented for HIV.  He denies any blood transfusions, no history of more recent travel, no history of animal contact or contact with sick kids. He is currently on no medications. He immigrated to USA in mid 2004 and currently a college student and works as part time travel insurance agent

On physical examination:

• Blood pressure 100/73, pulse is 122, respiratory rate is 18, and temperature is 95.5.  He is 94% on rebreather mask
• NECK:  Supple.  No JVD.  Thyroid not enlarged
• CHEST:  He has bilateral fine crackles all over his chest fields. 
• HEART:  Tachycardic, S1, S2, no murmur heard.
• ABDOMEN:  Bowel sounds are present.  He has massive splenomegaly, the spleen edge is palpable about 4 finger breadths below the costal margin.  No hepatomegaly.  No focal tenderness.
• EXTREMITIES:  The patient has some black keratotic spots on his lower extremities. 

Few hours later, patient went into PEA rhythm, resuscitation for 20 minutes was not successful, and limited autopsy was done.