A 58-years-old male with a history of splenectomy, presented to the emergency department with fever, malaise and body-ache noted after returning from a 8-day business trip to Brazil. He had also visited East Coast of USA about three weeks prior to this trip and gave a history of mosquito bites. His initial assessment included screening for multiple infectious diseases including titres sent for West Nile virus, Lyme disease, Hepatitis, EBV and malaria, all of which were found to be negative. Amongst the routine lab investigations sent, a blood film for CBC revealed intracellular ring forms in erythrocytes for which he was started on antimalarial therapy.
His myalgias and leg weakness continued to worsen along with continuing low-grade fever. Within a week, he noticed, for the first time, dark colored urine and lightheadedness. A malaria smear done this time was found to have multiple…
