Image 21: This man, 7 days out of Nigeria, presented with a 3 day history of fever and vomiting, He had 4.8% P. falciparum and platelets of 48,000/µl. An ultrasound showed a 13 cm spleen without defects. Vomiting with oral quinine was bothersome but he became afebrile by day 3 of treatment. He returned home and started a home renovation project the next day at which time he began to have severe pleuritic chest pain and left upper quadrant tenderness. This persisted for 5 days at which time he complained and a CT revealed an interesting spleen. The diagnosis was:
