Plasmodium ovale: Exploring an Atypical Presentation

Malaria is an infection caused by five different Plasmodium species. The most common are Plasmodium falciparum and vivax. Plasmodium ovale is more rarely reported and mostly has a benign course. We present a case of a 40-year-old male with a six-day history of headaches, chills, and fever who was initially evaluated in our emergency room, from where he was discharged after a negative workup for malaria. He returned to the hospital five days later in septic shock. Now P. ovale was found in a blood smear. The patient was treated with three doses of intravenous artesunate, followed by a three-day course of oral atovaquone-proguanil. After G6P deficiency and sickle cell tests were found to be negative, he was started on primaquine for 14 days to eradicate liver hypnozoites. The patient had a favorable outcome; the pancytopenia resolved, and he remained stable and was discharged home.