SHM Converge Scientific Abstract ePoster Gallery-Buzz Off Malaria!: When the Pest Requires Repeat Tests

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This case highlights a patient with intermittent high-grade fevers after undergoing multiple interventional radiology procedures for a pancreatic mass with splenic invasion, splenomegaly, and varices. Early symptoms were nonspecific: he was initially afebrile with an unremarkable exam, but labs showed anemia and leukopenia. Because fever began after embolization, clinicians first suspected post-embolization syndrome and later vaccine-related fever.<br /><br />A broad infectious workup was performed, including tests for malaria, chikungunya, dengue, and Zika, but initial results were negative. Despite this, the patient continued to have sporadic fevers and myalgias, leading to empiric antibiotics. When the fevers persisted, malaria testing was repeated. This time, rapid antigen testing and blood parasites were positive for Plasmodium falciparum, with parasitemia under 1%. He had no major systemic complications and improved after treatment with artemether-lumefantrine (Coartem), with resolution of fever.<br /><br />The case emphasizes several teaching points: malaria can present with paroxysms of fever and may be missed on initial testing, so repeat testing is important when clinical suspicion remains high. It also shows how cognitive biases can affect diagnosis—clinicians may anchor on more obvious explanations such as post-procedure inflammation or vaccination effects and overlook malaria. The case reinforces the need to consider malaria in patients with compatible fever patterns, especially when travel or exposure risk is possible, even if initial tests are negative.

Asset Subtitle

Tara K. Ward

Meta Tag

Author List Erin A. Szemak, Tara K. Ward

Category Clinical Vignettes

Concept Malaria

Concept Plasmodium falciparum

Concept Artemether-lumefantrine

Concept Intermittent Fever

Concept Paroxysmal fever

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Tara K. Ward

Track Adult

Keywords

Plasmodium falciparum

malaria

intermittent fever

high-grade fevers

post-embolization syndrome

interventional radiology

splenic invasion

repeat malaria testing

artemether-lumefantrine

diagnostic bias

Malaria

Plasmodium falciparum

Artemether-lumefantrine

Intermittent Fever

Paroxysmal fever