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Severe Plasmodium vivax Malaria in a 60-Year-Old Male: A Case Report of Complicated Malaria with Acute Renal and Respiratory Involvement
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Ahmad Najafi *    |
| Assistant Professor of Infectious Disease, Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran , najafiahmad1976@gmail.com |
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Abstract: (8 Views) |
Background: Plasmodium vivax malaria has traditionally been perceived as a milder form of malaria; however, it is increasingly recognized for its potential to cause severe and life-threatening complications, particularly in individuals lacking prior exposure or those experiencing delayed diagnosis. This case report details a 60-year-old male migrant from Afghanistan who presented with severe P. vivax malaria complicated by acute renal failure, respiratory distress, altered mental status, and co-infection with COVID-19. The patient received treatment at Beheshti Hospital in Kashan, Iran, in 2021.
Case Presentation: The patient, a 60-year-old male from Afghanistan, exhibited a 26-day history of fever, chills, jaundice, dark urine, and progressive weakness. Diagnosis of P. vivax malaria was established based on peripheral blood smear. Upon admission, the patient displayed unstable vital signs, and physical examination revealed jaundice, splenomegaly, and multiple petechiae. Laboratory tests indicated severe thrombocytopenia, hyperbilirubinemia, and impaired renal function. Initial treatment with Chloroquine Phosphate was administered; however, the patient's condition deteriorated, leading to respiratory failure that necessitated intubation and intensive care unit (ICU) management. Furthermore, the patient tested positive for COVID-19, complicating his treatment regimen. He was subsequently treated with intravenous artesunate, blood transfusions, and supportive care that included corticosteroids for COVID-19 management. In addition to treatment with chloroquine phosphate and injectable artesunate, the patient was prescribed a 14-day course of primaquine to mitigate the risk of malaria recurrence. After seven days in the ICU, the patient was extubated and demonstrated clinical improvement. He was discharged in stable condition with follow-up instructions.
Discussion: This case highlights the potential severity of P. vivax malaria, particularly in individuals from malaria-endemic regions who experience delayed diagnosis and multi-organ involvement. It emphasizes the necessity for early recognition, prompt initiation of antimalarial therapy, and multidisciplinary care in managing severe cases. The co-infection with COVID-19 further complicated treatment, highlighting the importance of integrated therapeutic approaches in complex clinical scenarios. Timely intervention and appropriate supportive care were pivotal to the patient's recovery, illustrating that severe P. vivax malaria can be effectively managed even in resource-limited settings.
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| Keywords: Plasmodium vivax, severe malaria, acute renal failure, respiratory distress, COVID-19 |
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Type of Study: Case Report |
Subject:
General
Received: 2026/02/23 | Revised: 2026/08/10 | Accepted: 2026/08/10
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