In April, 2012, a 32-year-old white man came to our hospital with fever, lethargy, dyspnoea, and bilateral ankle oedema. He had spent the last 4 months in Togo and had not taken malaria prophylaxis. 15 days previously, he had developed fever and lethargy, and had attended a clinic at which Plasmodium falciparum malaria was diagnosed, with an initial parasitaemia of 1650 parasites per uL. His haemoglobin (Hb) was 128 g/L. He was given 160 mg intramuscular artemether daily for 3 days, followed by a 3-day course of oral dihydroartemisinin/piperaquine, with a good symptomatic response. 2 days later, he had a recurrence of fever, in addition to dyspnoea and ankle swelling. A blood film showed no malaria parasites, but his Hb was 108 g/L. During the next 3 days he deteriorated and was transferred to hospital in Lome. A blood film was again negative for malaria parasites, but the Hb had dropped to 70 g/L. He was prescribed intravenous (IV) ofloxacin with oral doxycycline and was flown to London.
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机译：2012年4月，一名32岁的白人因发烧，嗜睡，呼吸困难和双侧踝部水肿来到我们医院。他在多哥度过了最后四个月，并未采取任何预防疟疾的措施。 15天前，他发烧和嗜睡，并去了一家诊断为恶性疟原虫疟疾的诊所，最初的寄生虫病为每uL 1650寄生虫。他的血红蛋白（Hb）为128 g / L。每天给他160毫克肌内蒿甲醚，持续3天，然后口服3天的双氢青蒿素/哌喹疗程，对症状的反应良好。 2天后，除了呼吸困难和踝关节肿胀外，他还发烧。血片未显示疟疾寄生虫，但他的血红蛋白为108 g / L。在接下来的三天里，他病情恶化，被送往洛美的医院。血膜再次显示疟原虫为阴性，但血红蛋白已降至70 g / L。他被处方口服氧氟沙星和强力霉素口服，然后飞往伦敦。
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