Malaria remains a significant global health problem, particularly in tropical regions. Although Plasmodium vivax infection is often considered benign, it possesses the unique ability to cause relapse through dormant liver stages known as hypnozoites. Delayed diagnosis may occur in non-endemic or low-incidence settings because malaria can mimic more common febrile illnesses such as dengue infection. We report a case of presumed relapse of P. vivax malaria in a 54-year-old female presenting in a non-endemic area with cyclical fever, chills, sweating, headache, nausea, and vomiting. The patient had a prior history of malaria infection one year earlier. Initial laboratory evaluation revealed significant thrombocytopenia with a platelet count of 47000/µL, raising initial suspicion of dengue fever. However, dengue NS1 antigen testing was negative. Species-specific malaria rapid diagnostic testing Plasmodium falciparum/P. vivax antigen (Pf/Pv Ag) and peripheral blood smear examination using Giemsa staining subsequently confirmed P. vivax infection. The patient was treated with dihydroartemisinin-piperaquine (DHP) followed by primaquine for radical cure, resulting in clinical and hematologic improvement. This case highlights the diagnostic challenges of presumed malaria relapse in non-endemic settings, particularly when overlapping clinical and hematological features with dengue infection may lead to initial misdiagnosis. Thorough travel history assessment, early recognition, and appropriate diagnostic testing are essential to ensure timely treatment and prevent complications.
Dewi et al. (Tue,) studied this question.