TTP Mimicry in Severe Malaria: A Clinical Challenge

Abstract Background Severe Plasmodium falciparum infection can present with life-threatening complications such as cerebral malaria and acute kidney injury, occasionally mimicking thrombotic thrombocytopenic purpura. Case presentation We report the case of a 45-year-old man who returned from Guinea without malaria prophylaxis. He presented with fever, vomiting, oliguria, and altered mental status. Peripheral blood smear revealed a parasitemia rate of 10%, with trophozoites and gametocytes of P. falciparum. Although initial findings suggested thrombotic thrombocytopenic purpura, the diagnosis was severe malaria with cerebral involvement and acute kidney injury. The patient was treated with intravenous artesunate and oral artemether-lumefantrine. Due to persistent anuria, multiple hemodialysis sessions were required. Neurological improvement was observed by day four, and parasitemia clearance was noted; however, dialysis continued for an additional two months. Renal function eventually normalized. Conclusions This report emphasizes the significance of travel history and blood smear examination in febrile patients with multi-organ dysfunction. Malaria prophylaxis remains critical for travelers to endemic areas.