TTP Mimicry in Severe Malaria: A Clinical Challenge

Background Severe Plasmodium falciparum infection can present with life-threatening complications such as cerebral malaria and acute kidney injury, occasionally mimicking thrombotic thrombocytopenic purpura. Case presentation We report the case of a 45-year-old man who returned from Guinea without malaria prophylaxis. He presented with fever, vomiting, oliguria, and altered mental status. Peripheral blood smear revealed a parasitemia rate of 10%, with trophozoites and gametocytes of P. falciparum . Although initial findings suggested thrombotic thrombocytopenic purpura, the diagnosis was severe malaria with cerebral involvement and acute kidney injury. The patient was treated with intravenous artesunate and oral artemether-lumefantrine. Due to persistent anuria, multiple hemodialysis sessions were required. Neurological improvement was observed by day four, and parasitemia clearance was noted; however, dialysis continued for an additional two months. Renal function eventually normalized. Conclusions This report emphasizes the significance of travel history and blood smear examination in febrile patients with multi-organ dysfunction. Malaria prophylaxis remains critical for travelers to endemic areas.