Severe Malaria Infection Concurrent With Autoimmune Hemolytic Anemia and Acute Cytomegalovirus Infection: A Case Report

Malaria infection causes lysis of infected red blood cells (RBCs), leading to anemia. Autoimmune hemolytic anemia (AIHA), on the other hand, is caused by antibody-mediated destruction of RBCs, and it is associated with other autoimmune disorders like systemic lupus erythematosus (SLE). Thereby, we report a rare case of concurrent malaria infection with AIHA and acute cytomegalovirus (CMV) infection. A 33-year-old female presented with fever for seven days. She came back from Ethiopia 40 days ago. She was found to have severe anemia, and further workup revealed high levels of immunoglobulin G (IgG) antibodies against RBC. She rapidly improved with antimalarial and prednisolone therapy. She was also found to have immunoglobulin M (IgM) against CMV, indicating acute infection, but she didn't have specific manifestations related to CMV and therefore was not treated. During outpatient follow-up, she was found to have high antinuclear antibody (ANA) titers as well as low complements, indicating the possibility of an underlying autoimmune disorder. This case underscores the need for concurrent antimalarial and immunosuppressive therapy in co-occurring autoimmune hemolytic anemia (AIHA)/malaria, with close monitoring for SLE progression given high ANA titers.