Postpartal endomyometritis in a case of unknown tertian malaria

A 28-year-old woman developed puerperal endomyometritis and tertian malaria simultaneously. She delivered her child by vacuum extraction during week 41 of pregnancy in September 1994. The peripartal period was uneventful. Nine days post partum the patient was readmitted to hospital with fever and pain in the area of the episiotomy. On day 13 post partum a hysterectomy was performed because of suspected abscess-forming endomyometritis. Two days after the hysterectomy the patient developed septic temperatures, which persisted for 10 days. Tertian malaria due to Plasmodium vivax was found to be the cause of fever. The patient had been in Indonesia without anti-malarial prophylaxis in 1991. Two years later she travelled to Ghana, having taken mefloquine as prophylaxis. Malaria was obviously caused by reactivated hypnozoites in the liver, although the patient had never had an episode of fever associated with malaria before. This case proves that tertian malaria may "recur" even without previous manifestation, years after a stay in a region endemic for malaria.