Occurrence of Plasmodium vivax in a nonendemic area: A case report

Background: Bali, as a popular tourist destination, is generally considered a low-endemic area for malaria; locally acquired cases are rare. However, sporadic Plasmodium vivax infections in Bali have raised concerns about this region's potential reservoirs and transmission dynamics. This case report highlights a rare and unusual presentation of Plasmodium vivax malaria in Bali. The report aimed to emphasize the importance of heightened clinical awareness in low-endemic areas and to discuss the potential implications for diagnosis. Case presentation: A 40-year-old man with the initials A came to the Emergency Unit of Negara Hospital with a primary complaint of fever. The fever had been felt in the past month before and had been continuous, accompanied by chills and weakness. The fever was felt throughout the body and was said to occur every three days. There was a history of traveling to an endemic area of ​​malaria, namely Jayapura, two months before the fever appeared. Laboratory examination found microcytic hypochromic anemia. The morphology of peripheral blood gave the impression of anisopoikilocytosis with Plasmodium vivax malaria parasites in the trophozoite stage. Conclusion: This case underscores the importance of integrating clinical pathology and laboratory findings into the diagnosis and management of Plasmodium vivax malaria, particularly in regions like Bali, where it is considered rare.