Challenges of Diagnosing Severe Malaria with Complications in Adult Patients: A Case Report

Background: Malaria is known to be the main cause of death in malaria-endemic areas. The authors report a case of severe malaria in an adult with no history of travel from an endemic area with good outcomes after hospitalization. Case Presentation: A 46-year-old man was brought to the Emergency Room (ER) because of fever and chills for six days. Complaints were accompanied by nausea and vomiting three times a day. Patients also experience headaches, weakness, coughing, and runny nose. The patient had no history of traveling from a malaria-endemic area. The patient was transferred from the Emergency Department (ED) to the High Care Unit (HCU), and during one day of intensive medical care at the HCU, there was a clinical deterioration characterized by dyspnea, icteric sclerae, acral edema, tenderness in both calves, and rash in the abdominal area. Due to worsening respiratory function, the patient was placed on a ventilator. During intensive medical treatment, the patient continued to show deterioration. The clinical findings suggest a possible feature of Weil's disease or fulminant hepatitis, and although the patient was on intensive care, there was no clinically significant improvement. Furthermore, microscopic blood smear examination and rapid diagnostic tests (RDTs) for malaria were carried out on the 4th day of treatment with negative results. As there was no clinically significant improvement, it was decided to take a blood smear and repeat RDT on the twelfth day, and it showed a positive result for falciparum malaria. Subsequently, artesunate was administered intravenously, and the patient's condition began to improve with a negative parasite count the following day. The patient was discharged in good clinical condition on day 25 of treatment. Conclusion: Good quality malaria diagnostic techniques are essential to diagnose malaria. A timely diagnosis of malaria has the potential to save the patient. Because Jakarta is not a malaria endemic area, it was concluded that this case was an imported malaria case.