# A Rare Presentation of Plasmodium vivax Malaria: Pancytopenia due to Hemophagocytic Syndrome in a Pregnant Woman

## TL;DR

A pregnant woman with Plasmodium vivax malaria developed a rare condition called hemophagocytic syndrome, causing pancytopenia, and recovered after treatment.

## Contribution

This is the first documented case of hemophagocytic syndrome-induced pancytopenia in a pregnant woman with Plasmodium vivax malaria.

## Key findings

- P. vivax malaria in a pregnant woman presented with hemophagocytic syndrome and pancytopenia.
- The patient fully recovered after antimalarial and supportive treatment.
- The case underscores the importance of timely diagnosis in preventing severe outcomes.

## Abstract

Background: Malaria poses a significant public health challenge, especially in pregnant women, due to potential complications for both mother and fetus. The occurrence of pancytopenia as an initial manifestation of acute Plasmodium vivax malaria is extremely rare, with most cases reported in Plasmodium falciparum (P. falciparum) malaria infections. To the best of our knowledge, there are no documented cases of pancytopenia due to hemophagocytic syndrome (HPS) associated to P. vivax malaria in pregnant women.

Case Presentation: A 22-year-old gravida one woman from Debre Berhan, Ethiopia, who was nine weeks pregnant, presented with a high-grade fever, headache, nausea, vomiting, joint pain, and fatigue lasting for 1 week. She had recently traveled to a malaria-endemic region. Upon examination and investigation, she was found to be hypotensive and febrile, with pale conjunctiva, hepatosplenomegaly, and pancytopenia, along with elevated levels of triglycerides and serum ferritin. Blood smear analysis showed the trophozoite and gametocyte stages of P. vivax. She was diagnosed with HPS based on clinical criteria. The patient achieved full recovery following antimalarial and supportive treatment.

Conclusion: This case highlights a rare but serious presentation of P. vivax malaria in a pregnant woman, characterized by HPS and resultant pancytopenia. Timely diagnosis and effective treatment are crucial for achieving good outcomes for both the mother and the fetus, highlighting the importance of increased awareness in clinical practice.