Resolution of severe autoimmune hemolytic anemia and thrombocytopenia associated with Plasmodium vivax malaria without corticosteroid therapy: A case report

Abstract

Rationale: Autoimmune hemolytic anemia is a rare but potentially life-threatening complication of Plasmodium vivax malaria. Most reported cases required corticosteroid therapy in addition to antimalarial treatment. Patient concerns: We report the case of a 28-year-old Ethiopian man who presented with fever, pallor, and fatigue. Diagnosis: Laboratory evaluation revealed severe anemia (hemoglobin 6 g/dL), thrombocytopenia (88,000/µL), hyperbilirubinemia, and a positive direct antiglobulin test. Peripheral smear confirmed P vivax infection with 2% parasitemia. Comprehensive immunohematological testing, including direct antiglobulin test, elution, adsorption, and extended antigen typing, confirmed immune-mediated hemolysis and excluded alloantibody-related incompatibility. Interventions: The patient received 3 compatible blood transfusions and was treated with intravenous artesunate followed by primaquine, without corticosteroids or platelet transfusion. Outcomes: By day 5, hemoglobin improved to 10.2 g/dL, platelets normalized, and malaria smears were negative. He was discharged in stable condition. Lessons: This report highlights an unusual presentation of P vivax malaria complicated by severe autoimmune hemolytic anemia and thrombocytopenia, which resolved with antimalarial therapy alone, without immunosuppressive therapy, including corticosteroids. This finding suggests that corticosteroids may not always be necessary in certain cases and underscores the importance of early recognition and comprehensive immunohematological evaluation in malaria-related cytopenias.