ABSTRACT
HISTORY AND ADMISSION FINDINGS: A 67-year-old woman was admitted with pyrexia of unknown cause preceded by transitory peripheral pareses. She had not been to any malaria-infested regions. Within 4 days a "sepsis syndrome" developed with acute respiratory and renal failure. INVESTIGATIONS: Initially there were no pointers to organ involvement, either clinically or by ultrasound, in the electrocardiogram, radiographically or by computed tomography. Haematological and other laboratory tests indicated a bacterial infection. But 6 days after starting intensive treatment a blood smear revealed Plasmodium falciparum. TREATMENT AND COURSE: Administration of mefloquine and quinine quickly reduced the parasite count (from 10% to 1%), no parasite being found in the blood smear on the 5th day. But severe complications developed: perforation of a duodenal ulcer, exudative pancreatitis, cholangitis, diffuse bleeding into the large intestine and a chronic capillary leakage syndrome. But the patient was finally cured and discharged to a convalescent home after 160 days in hospital, 135 of them in intensive care. CONCLUSION: The source of the malaria could not be identified. "Baggage malaria" is more likely than the bite of a mosquito expelled from the "plane's undercarriage" well as it approached Frankfurt airport (the patient lived under one of the approach sectors, 30 km from the airport). As there are no screening procedures, imported malaria should be thought of in case of fever of unknown cause without history of foreign travel; a blood smear should be done.
