When malaria hides: a case report of sudden coma without prior fever in cerebral malaria

Malaria is a major global health burden. Severe malaria, including cerebral malaria (CM), significantly increases mortality and requires immediate treatment. CM often manifests as loss of consciousness and behavioural changes. In this case, a 19-year-old woman presented with sudden unconsciousness and rigor. Fever before admission was denied, but later developed during hospitalization. Given the patient's residence in a malaria-endemic area, a rapid diagnostic test (RDT) was performed and was positive. Microscopic examination was delayed but later confirmed Plasmodium falciparum infection. The patient was treated with intravenous artesunate, followed by primaquine and dihydroartemisinin-piperaquine (DHP). The patient improved following treatment; follow-up microscopy confirmed parasite clearance.