A case of Plasmodium vivax malaria presenting as acute cerebral infarct.

Malaria is a protozoan disease caused by the bite of a female anopheline mosquito which is infected by the protozoa Plasmodium. It is the world’s third-ranked infectious killer disease after HIV/AIDS and tuberculosis1. Currently, six species of Plasmodium (P. falciparum, P. vivax, two sympatric species of P. ovale, P. malariae, and P. knowlesi) are known to cause malaria2. Of these, P. vivax was responsible for 13.8 million cases of malaria in 2015, with most cases (76%) occurring in the Southeast Asia Region (SEAR) where India and Pakistan share the burden3. Previously, complicated malaria was considered to be exclusively due to P. falciparum. However, over the recent years, reports from different parts of world have shown that P. vivax has similar if not equal potential to cause complications. Multiple cases of severe malaria due to P. vivax have been reported with complications, like anaemia, hepatic dysfunction, renal failure, cerebral malaria, ARDS4-7 and retinal haemorrhage8. Various neurological complications have been reported with P. falciparum malaria including cerebral infarct, but such manifestations have been reported intermittently in case of P. vivax9-10. Here, we report a unique case of acute cerebral infarct due to P. vivax malaria in a previously healthy young adult. This case report highlights the atypical presentations of vivax malaria which clinicians should be aware of, while making differential diagnosis in endemic zones as well as hypoendemic zones of malaria.