Malaria in Appalachia? A Rare Case of Plasmodium vivax in an Adolescent Exchange Student From South Korea

Cultural globalization, including the resumption of international travel post-SARS-CoV-2 pandemic, emphasizes the importance of regional infectious disease variation, especially when considering a differential diagnosis for fever in a traveler. Prompt diagnosis is often imperative to initiate proper treatment and reduce morbidity and mortality associated with many environmental and vector-borne pathogens. The Anopheles mosquito transmits malaria in areas endemic to malaria. Malaria, while not endemic to the United States, can be seen in a traveler. This illness can be deadly if left untreated. Symptoms of malaria include but are not limited to jaundice, cyclic fever, and flu-like illness. In this case report, we describe a unique presentation of Plasmodium vivax malaria in a 17-year-old traveler from South Korea with a negative rapid malaria test. A peripheral smear from microscopy demonstrated the presence of gametocytes, which are pathognomonic for malaria. Despite the presence of a very low parasitemia (<1%), the patient was noted to have some severe features such as significant thrombocytopenia, acute kidney injury, as well as relapsed disease several months later despite adequate treatment. A high clinical index of suspicion and a detailed history allowed prompt treatment and no permanent sequelae.