Background: Malaria continues to be a significant global health challenge, caused predominantly by Plasmodium falciparum and Plasmodium vivax. While its classical manifestations are well described, rare and atypical organ-specific complications are increasingly recognized and may mimic other tropical diseases, delaying diagnosis and management. Objective: This study aimed to identify the spectrum of rare clinical and hematological manifestations of malaria and describe patient outcomes following appropriate therapy. Methods: This retrospective case series analyzed twelve adult patients with confirmed malaria who presented with unusual complications between June 2023 and August 2025. Demographic, clinical, laboratory, and radiological data were retrieved from hospital records. Diagnosis was confirmed by peripheral smear and rapid diagnostic testing. Patients were treated with intravenous artesunate-based regimens and organ-specific supportive measures. Results: Of the 12 patients (mean age 47.7 years; 7 males, five females), nine were infected with P. vivax and three with P. falciparum. Rare complications included splenic abscess, subcapsular splenic hematoma, liver abscesses, acute hepatic failure, acute pancreatitis, myocarditis, ischemic stroke, seizures due to severe hyponatremia, prolonged thrombocytopenia, severe thrombocytopenia with bleeding, and hemophagocytic lymphohistiocytosis. Most patients (91.6%) achieved complete recovery with timely intervention, while one patient with P. falciparum and hemorrhagic cerebral infarction had a poor outcome. Discussion: This study demonstrated that P. vivax, once considered benign, can cause severe, multi-organ disease comparable to that caused by P. falciparum. Mechanisms, such as microvascular sequestration, immune dysregulation, and cytokine-mediated injury, may underlie these rare presentations. Recognition of such complications is crucial to avoid diagnostic delays and to ensure timely initiation of therapy. Conclusion: Malaria can present with diverse and severe atypical manifestations, particularly due to P. vivax. Early recognition and prompt treatment are crucial for favorable outcomes. Clinicians in endemic areas should maintain a high index of suspicion for such rare presentations to reduce morbidity and mortality.
Singh et al. (Wed,) studied this question.