{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:10:50Z","timestamp":1790604650028,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Plasmodium vivax<\/jats:italic>\n (\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n ) malaria, once regarded as a comparatively benign infection, is increasingly recognized as a cause of severe, potentially life\u2010threatening multisystem disease. Concurrent secondary hemophagocytic lymphohistiocytosis (HLH), disseminated intravascular coagulation (DIC), and acute pancreatitis complicating\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n infection is exceptionally rare. A previously healthy 19\u2010year\u2010old Bangladeshi woman presented with a 5\u2010day history of high\u2010grade fever with rigors, generalized weakness, and upper abdominal pain. Laboratory evaluation demonstrated pancytopenia, markedly elevated ferritin (28,839\u2009ng\/mL), hypertriglyceridemia, hypofibrinogenemia, elevated transaminases, coagulopathy, and elevated pancreatic enzymes. Malaria rapid diagnostic testing (RDT) was positive for\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n ; peripheral blood smear was negative and PCR was unavailable. The patient fulfilled six HLH\u20102004 diagnostic criteria, met International Society on Thrombosis and Hemostasis (ISTH) criteria for overt DIC, and satisfied revised Atlanta criteria for acute pancreatitis. Intravenous artesunate with multidisciplinary supportive care resulted in progressive clinical and biochemical improvement. HLH\u2010directed immunosuppressive therapy was not required. She was transitioned to oral artemether\u2013lumefantrine and primaquine for radical cure and remained asymptomatic at follow\u2010up. This case illustrates the evolving recognition of\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n as a pathogen capable of triggering complex hyperinflammatory and multisystem complications. Early identification of underlying infection and prompt antimalarial therapy may be sufficient to achieve remission in infection\u2010associated HLH without immunosuppression. Clinicians in endemic regions should maintain heightened vigilance for these rare but life\u2010threatening complications.\n <\/jats:p>","DOI":"10.1002\/ccr3.73581","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:28:23Z","timestamp":1790602103000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe\n Plasmodium vivax<\/i>\n Malaria Complicated by Secondary Hemophagocytic Lymphohistiocytosis, Disseminated Intravascular Coagulation, and Acute Pancreatitis: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1929-9455","authenticated-orcid":false,"given":"Tasnim","family":"Nafian","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7771-1065","authenticated-orcid":false,"given":"Md. Abul Kalam","family":"Azad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6204-0501","authenticated-orcid":false,"given":"Khaled Mahbub","family":"Murshed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5221-0021","authenticated-orcid":false,"given":"Kazi Ali","family":"Aftab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6499-6323","authenticated-orcid":false,"given":"Rubayet","family":"Shahriar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4496-8932","authenticated-orcid":false,"given":"Abdullah Al","family":"Faisal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)31096\u20107"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003890"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.12366"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879\u2010020\u201005046\u2010y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01148"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/hematology.2023000509"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010\u2010023\u201002104\u2010w"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2018894618"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.40042"},{"issue":"9","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.9734\/ajrid\/2025\/v16i9488","article-title":"Unmasking a Rare and Fatal Presentation of Plasmodium vivax Malaria as Acute Pancreatitis in a Patient","volume":"16","author":"Varshney L.","year":"2005","journal-title":"Asian Journal of Research in Infectious Diseases"},{"key":"e_1_2_12_12_1","unstructured":"WHO Guidelines for Malaria https:\/\/www.who.int\/publications\/i\/item\/guidelines\u2010for\u2010malaria."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.09.016"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665\u20109913(23)00273\u20104"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21423"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38690"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2025.03.038"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.4068\/cmj.2011.47.3.173"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr\u20102016\u2010215366"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hemonc.2016.06.001"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/tp.TP_44_19"},{"issue":"5","key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1055\/s-0037-1616068","article-title":"Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular Coagulation","volume":"86","author":"Taylor F. 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