DELAYED DIAGNOSIS OF IMPORTED PLASMODIUM VIVAX MALARIA MIMICKING REFRACTORY MIGRAINE

Malaria is referred to as imported malaria in countries outside malaria-endemic areas such as Morocco. The aim of our study was to highlight the importance of epidemiological data for the diagnosis of imported malaria. A 29-year-old moroccan female, presenting with a 3-month history of headache unresolved with usual analgesics, for which she was put on antidepressants and neuroleptics. She then presented to the emergency department with nausea, vomiting, abdominal pain, and fever. History and clinical examination revealed only mild abdominal pain with fever. Blood count showed anemia at 10.4 g/dl, MCHC at 34, MCH at 32, MCV at 90 fl and reticulocytes at 157920.Symptomatic treatment was given and the patient was referred to the haematology department for etiological diagnosis of her regenerative normocytic normochromic anaemia.Patient was then referred to Internal Medicine, the patient reported having visited Pakistan 1 year previously.In view of this situation, and taking into account the fact that she had travelled to a malaria-endemic area, a thin blood smear (TBS) and a thick blood smear stained with MGG were carried out urgently. A diagnosis of P. vivax malaria was established. Results were communicated immediately to the attending physician, and treatment was administered in an outpatient setting.