Case Presentation

A 37-year-old African American male presented to the hospital complaining of high fevers over the past two weeks associated with severe posterior headache. He described having had a very poor appetite recently, but denied any cough, abdominal pain, diarrhea, or urinary symptoms. He did not recall sustaining any head trauma. He did relate, however, that he had recently returned from a three-month trip to Kenya ~1 month prior to this presentation. He had no past medical history and was not on any medications. He did not use IV drugs. Physical exam confirmed a fever of 102.1o F though normotensive 110/82 mm Hg and a resting heart rate 110 bpm. The complete physical exam including cardiopulmonary, abdominal, and neurological examination was normal. Laboratory analysis was unrevealing. A head CT performed prior to the lumbar puncture also failed to reveal any abnormalities. However, given the patient’s recent travel history, the team empirically began him on antimalarial treatment against P. falciparum (quinine sulfate 10 mg/kg every eight hours and doxycycline 100mg po bid) while awaiting confirmatory histologic diagnosis. The next day malaria was confirmed when the results of the thick and thin smear were positive for plasmodium with a viral level greater than 1%. During his hospitalization he was noted to have recurrent fevers occurring almost every other day. His clinical status remained stable without any alterations of his laboratory data. He was discharged to complete his course of oral medications.