Malaria has various causative agents that can have a spectrum of disease manifestations, some potentially fatal. Various species have been established as etiologies of malaria, though our understanding of the severity of various species is changing.

We present a unique case of Plasmodium vivax malaria that resulted in severe disease, a magnitude rarely seen in previous literature. Our patient was a 35-year-old healthy woman who presented to the emergency department with abdominal pain, nausea, vomiting, and fever.

Further workup revealed severe thrombocytopenia with prolonged prothrombin (PT) and partial thromboplastin time (PTT).

An initial thick smear failed to detect any Plasmodium species, but a thin smear revealed P. vivax.

The patient’s hospital stay was complicated by septic shock requiring intensive care unit (ICU) admission.

This unique case represents P. vivax as the causative agent of severe malaria even in healthy, immunocompetent patients.

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