Introduction Malaria, caused by plasmodium falciparum is a life threatening condition, more so in pregnancy. Other plasmodium parasites such as vivax do not usually cause severe malaria, and especially, not in women from malaria endemic areas. Here we present a case of severe plasmodium vivax malaria complicated by atypical pneumonia.

Case report A primi-gravida at 27⁺³ weeks gestation was admitted with seven days history of fever, headache, and feeling generally unwell. Blood film requested by her general practitioner identified trophozoites of plasmodium vivax. She booked at 25 weeks gestation, having recently moved to the UK from Pakistan. On admission she was pyrexial (39.7 °C), with tachycardia (142/min) and tacchypnoea. Initial blood tests showed haemolysis and evolving thrombocytopenia (39 x 10⁶ /ml). Despite early commencement of antimalarial therapy, she developed acute respiratory distress syndrome necessitating intensive care management. As her condition deteriorated further an emergency caesarean section was performed at 27⁺⁶ weeks gestation. Following the caesarean section, intensive antimalarial, anti-atypical pneumonia, swine flu, and antibacterial therapy, she made complete recovery over the next 12 days. Follow up microbiology tests revealed that she also had Mycoplasma Pneumonia (total Ab levels >320).

Conclusion Severe cases of malaria in pregnancy can cause severe morbidity and mortality. A multidisciplinary team approach is essential for a favourable outcome. A thorough search for concomitant conditions should be made in cases where the clinical picture deviates from the expected natural history of the disease process. Aggressive treatment should aim to reduce mortality and the risk of fetal loss.