Locally Acquired Plasmodium falciparum Malaria in a Non-endemic Region of Lebanon: A Case Report

Malaria is a parasitic disease caused by several Plasmodium species, transmitted through the bite of infected Anopheles mosquitoes, and capable of causing mild to life-threatening illness. In non-endemic areas, sporadic cases present a significant diagnostic challenge, where delay in recognition can lead to severe outcomes and death. In this case report, we present a rare case of locally acquired P. falciparum malaria in Lebanon, in a 70-year-old Lebanese female with no history of travel to endemic regions, who presented with intermittent fever, chills, headache, nausea, and abdominal pain. Laboratory tests showed anemia, thrombocytopenia, and leukopenia. Microscopic investigations on peripheral blood smear revealed intraerythrocytic ring forms, and a rapid diagnostic test (RDT) confirmed P. falciparum infection. Given the patient's age and high parasitemia, she was treated with intravenous artesunate, followed by oral artemether-lumefantrine, and subsequently made a full recovery. The absence of conventional exposure routes, such as travel, blood transfusion, or organ transplant, makes this case a significant diagnostic and public health challenge. This case highlights the need for sustained malaria surveillance and heightened awareness among clinicians in historically non-endemic areas.