Ahmed B., 1

Ahmed Bukar Mohammed is a nine-month-old boy who lives with his parents and two siblings in a rented two-room apartment in Maiduguri. His father, Muhammad, works as a labourer earning about ₦15,000 monthly, while his mother, Kaltum, earns approximately ₦10,000 from selling groundnuts. With an annual rent of ₦40,000 and limited income, the family struggles to meet basic needs and afford medical care for Ahmed. Ahmed presented with three days of high-grade fever, chills, poor feeding, and excessive crying. He also had four episodes of watery, non-bloody diarrhoea and two episodes of vomiting within 24 hours. His parents noticed bilateral red eyes with watery discharge, consistent with acute haemorrhagic conjunctivitis (Apollo). He had no convulsions, cough, or breathing difficulty. Ahmed had no previous hospital admission and was not fully immunized.

Ahmed was admitted with 3 days history of high grade fever, poor feeding, watery diarrhea, vomiting, and bilateral red eyes. RDT and MP were positive for P. falciparum +++. He was managed with IV Artesunate for 3 days, then completed with oral ACT. IV fluids and Zinc + ORS were given for dehydration and diarrhea. Tetracycline eye ointment was applied for Apollo. His fever subsided by day 2, diarrhea stopped by day 3, and eye redness improved significantly. He tolerated feeds well and was clinically stable for discharge on oral medications.

Ahmed presented with concurrent severe malaria and diarrhea putting him in a highly critical clinical state where the combination of systemic parasitic infection and rapid gastrointestinal fluid loss severely escalates the risk of life-threatening hypovolemic shock, profound electrolyte imbalance, and metabolic acidosis. Ahmed is expected to recover fully from severe malaria, the diarrhoea and Apollo will resolve, and he can resume normal feeding and growth with no lasting effects. If treated early, it will prevent complications such as cerebral malaria, severe anemia, and severe dehydration. If left untreated, the condition can rapidly progress to convulsions, coma, organ failure, and may become life-threatening.