Atypical presentation of falciparum malaria in a returning traveler: a diagnostic dilemma

Falciparum malaria, caused by Plasmodium falciparum, is a significant global health concern, especially in tropical regions. This case report details an atypical presentation of falciparum malaria in a 32-year-old male who returned to India after traveling to South Africa. The patient presented with a two-month history of high-grade fever, severe anemia, jaundice, easy fatigability, and significant weight loss. Initial laboratory investigations revealed severe anemia, thrombocytopenia, elevated inflammatory markers, and splenomegaly, but peripheral blood smears were negative for malaria parasites. Despite initial challenges in diagnosis, bone marrow aspiration confirmed the presence of P. falciparum. The patient was treated with artemether/lumefantrine, resulting in clinical and hematological improvement. This case highlights the importance of considering malaria in patients with unexplained anemia and splenomegaly, especially those with recent travel to endemic areas, even when initial diagnostic tests are negative. It underscores the value of comprehensive diagnostic approaches, including bone marrow examination, in atypical cases. This report contributes to the understanding of malaria's varied clinical presentations and reinforces the need for awareness and timely intervention to prevent complications.