A Rare Presentation of <i>Plasmodium vivax</i> Malaria: Pancytopenia due to Hemophagocytic Syndrome in a Pregnant Woman

<b>Background:</b> Malaria poses a significant public health challenge, especially in pregnant women, due to potential complications for both mother and fetus. The occurrence of pancytopenia as an initial manifestation of acute <i>Plasmodium vivax</i> malaria is extremely rare, with most cases reported in <i>Plasmodium falciparum (P</i>. <i>falciparum)</i> malaria infections. To the best of our knowledge, there are no documented cases of pancytopenia due to hemophagocytic syndrome (HPS) associated to <i>P</i>. <i>vivax</i> malaria in pregnant women. <b>Case Presentation:</b> A 22-year-old gravida one woman from Debre Berhan, Ethiopia, who was nine weeks pregnant, presented with a high-grade fever, headache, nausea, vomiting, joint pain, and fatigue lasting for 1 week. She had recently traveled to a malaria-endemic region. Upon examination and investigation, she was found to be hypotensive and febrile, with pale conjunctiva, hepatosplenomegaly, and pancytopenia, along with elevated levels of triglycerides and serum ferritin. Blood smear analysis showed the trophozoite and gametocyte stages of <i>P</i>. <i>vivax</i>. She was diagnosed with HPS based on clinical criteria. The patient achieved full recovery following antimalarial and supportive treatment. <b>Conclusion:</b> This case highlights a rare but serious presentation of <i>P. vivax</i> malaria in a pregnant woman, characterized by HPS and resultant pancytopenia. Timely diagnosis and effective treatment are crucial for achieving good outcomes for both the mother and the fetus, highlighting the importance of increased awareness in clinical practice.