Malaria cases are often misdiagnosis by clinicians in tropical areas like Indonesia.Some cases show overlapping signs and symptoms with another infection that are common in tropical areas such as typhoid, dengue and leptospirosis. It can be misdiagnosed in practice and led to a wrong management that can end fatally. Severe malaria is usually caused by Plasmodium falciparum. Plasmodium vivax (P. vivax) can also cause severe malaria but the cases reported are uncommon. Since infections with severe P. vivax that generally results in serious disease is quite uncommon in Indonesia, their identification and management is important. We report a case of severe malaria patient with sepsis and renal injury and hepatic impairment associated with malaria in a 70-year-old male. Clinical manifestations included anemia, sepsis, and elevated serum of creatinine, urea, total bilirubin and procalcitonin. The rapid diagnostic test for malaria and microscopic examination of blood smears were positive for P. vivax. The patient was treated as  severe  malaria with intravenous artesunate for six days, followed by oral treatment of  primaquine for 14  days. Intravenous fluid therapy, antipyretic, anti-malaria and antibiotic treatment were administered. The patient was stable and then discharged from the hospital. The prognosis depends much on early diagnosis and appropriate supportive treatment.

 

Keywords: malaria vivax, sepsis, artesunate