Malaria: a masquerader of cytopenias in leukemia

In developing countries where the prevalence of malaria and cancer are high it can be expected to occur together. 6-year-old male child, a known case of B cell acute lymphoblastic leukemia, on maintenance phase of chemotherapy presented to us with fever. His initial investigations showed no identifiable focus or significant abnormalities. He continued to have high grade fever spikes in spite of stepping up antibiotics. A week after admission he was found to have cytopenias and mild splenomegaly. Peripheral smear and bone marrow aspiration study showed enlarged RBCs infested by Plasmodium vivax. We report this case to make the clinicians aware that malaria can be cause of fever in patients on cancer treatment.