Out of Sight, Should not be out of mind: A perplexing case of Malaria

Malaria diagnosis is often difficult in cases with low parasitaemia and atypical presentations. We report a 30-year-old male with high-grade fever, chills, and vomiting. At admission, he was afebrile, pale, and had progressive splenomegaly. Despite extensive investigations, including multiple peripheral blood smears and malaria rapid diagnostic tests, results were negative. Bone marrow examination revealed rare red blood cells with Plasmodium spp., confirmed by PCR from the marrow aspirate slide. He completely recovered after treatment with Artemether-Lumefantrine and Primaquine. This case underscores the value of bone marrow microscopy and PCR in diagnosing malaria in patients with unexplained cytopenias and splenomegaly.