Severe Plasmodium falciparum Malaria Presenting with Gastrointestinal Symptoms in South Sudan: A Case Report.

Severe Plasmodium falciparum malaria typically presents with fever, chills, and features of multiple organ dysfunction; however, gastrointestinal manifestations may occur early and can be mistaken for gastrointestinal infection. We report the case of a 29-year-old Ghanaian man working in South Sudan who initially presented with nausea, vomiting, and diarrhea. He had not taken malaria chemoprophylaxis and reported inconsistent use of mosquito-prevention measures. He was first diagnosed with acute gastrointestinal infection and treated accordingly. After 24 hours, he developed high-grade fever, headache, tachycardia, and hypotension. On admission, a malaria rapid diagnostic test (RDT) (Bioline Malaria Ag P.f/Pan, Abbott Diagnostics Korea Inc.) was positive; peripheral blood smear microscopy revealed P. falciparum parasitemia graded as (++). Vital signs showed a heart rate of 120 beats/min and blood pressure of 85-90/55 mmHg. Laboratory findings included elevated total bilirubin (39.6 µmol/L) and creatinine (120 µmol/L), prolonged prothrombin time (22.4s), INR 1.84, and thrombocytopenia (platelet count 50 ×109/L). The patient was diagnosed with severe malaria and was treated promptly with intravenous fluids and intravenous artesunate, along with resuscitation and supportive care. After 3 days, he became afebrile, hemodynamically stable, and was transferred to a primary-level hospital for follow-up. This case highlights that gastrointestinal-onset severe malaria may delay diagnosis; early recognition and timely treatment are critical determinants of a favorable prognosis.