Cerebral Malaria Due to Plasmodium Vivax: An Unexpected Presentation

Cerebral malaria (CM) is a severe encephalopathy typically caused by Plasmodium falciparum (P. falciparum), presenting with altered consciousness, confusion, psychomotor agitation, and/or seizures. Diagnostic criteria require the laboratory confirmation of P. falciparum infection, alongside the systematic exclusion of alternative etiologies for encephalopathy. However, rare cases implicating Plasmodium vivax (P. vivax) as the causative agent have been reported. Pakistan is endemic for P. vivax, generally considered a benign cause of malaria, and encephalopathy is almost never encountered in clinical practice. This study presents a rare case of CM in a 16-year-old boy caused solely by P. vivax, confirmed on thick and thin peripheral smears showing rings and trophozoites. The patient was started on intravenous artesunate, to which he responded well, and was discharged on primaquine for radical cure. This case highlights the need for clinical vigilance, timely intervention, and recognition of P. vivax as a potential cause of CM, particularly in endemic regions.