Discrepant autopsy diagnosis of death due to cerebral Malaria

Malaria is the most important parasitic disease of man. Plasmodium falciparum infection is an emergency because of risk of cerebral malaria that is the most severe complication. Malaria diagnosis is usually made on blood samples of feverish patients coming from endemic areas. Although most of the cases of fatal cerebral malaria are diagnosed well before the patient's death, occasionally autopsy surgeon encounter cases in which the presence of cerebral malaria was not suspected prior to death.

We present two cases of cerebral malaria which were clinically undiagnosed. Medico-legal autopsy was started with history available from hospital records and police investigation report. On the basis of macroscopic and histopathological findings the patient was considered to have died of malignant cerebral malaria with multiple organ failure. These cases demonstrate the role a forensic pathologist may play in determining the natural cause of death like cerebral malaria.