Abstract
Severe malaria is usually caused by Plasmodium falciparum infection, which causes life-threatening cerebral, respiratory, renal, hepatic, hemodynamic, and hematologic dysfunction. In contrast, most Plasmodium vivax infections are mild. We report a case of P. vivax malaria with some of the above complications. A 59-year-old man presented with 1-day history of high-grade fever, after recently returning from Guyana. A peripheral blood smear as part of the initial workup showed numerous red blood cells with schizonts consistent with Plasmodium infection. Several blood tests including a DNA polymerase chain reaction were sent for parasite species identification. The patient was started on quinine and doxycycline oral therapy because of concerns regarding chloroquine-resistant malaria. Subsequently, during the next 4 days, the patient developed severe thrombocytopenia, nonoliguric renal, acute respiratory, and circulatory failure. He received an exchange transfusion to treat P. falciparum infection, suspected at the time because of the severity of his symptoms. The next day, however, the results of the DNA polymerase chain reaction of the blood revealed the parasite to be P. vivax instead.
