Collapsing Glomerulopathy in a Patient With Malaria and Multiple Myeloma: A Case Report.

Collapsing glomerulopathy is a severe form of focal segmental glomerulosclerosis (FSGS) that can occur as a primary or secondary condition, often in the context of infections such as HIV. Multiple myeloma can cause kidney injury through mechanisms such as cast nephropathy, while malaria-associated kidney injury is most often due to acute tubular necrosis. We present the case of a 47-year-old male of African descent with well-controlled HIV infection who became critically ill with severe AKI requiring intensive care and renal replacement therapy. A blood smear confirmed Plasmodium falciparum infection, and the clinical course was further complicated by a previously undiagnosed multiple myeloma. Given the multiple potential etiologies, a kidney biopsy was performed, which ruled out myeloma-associated kidney injury and revealed collapsing glomerulopathy. The temporal association with the malaria infection, together with the well-controlled HIV status, pointed to malaria-associated collapsing glomerulopathy as the most likely diagnosis. This case highlights the diagnostic challenges of AKI in critically ill patients with overlapping comorbidities and underscores the value of kidney biopsy in guiding the differential diagnosis.