Protracted Febrile Illness and Coma in an Adolescent with Sickle Cell Disease and Malaria

A 15-year-old adolescent with sickle cell disease (SCD) presented at a tertiary care children's hospital with severe hemolysis after returning from West Africa. Over a period of 5 weeks, the patient experienced recurrent hemolysis, fever, and neuropsychiatric symptoms, with worsening conditions despite immunosuppressive and broad-spectrum antibiotic treatment. Eventually, cerebral malaria (CM) was diagnosed and treated, leading to a prompt recovery; however, another episode of hemolysis occurred 12 days after artesunate treatment. The unusually prolonged course of CM in this case illustrates the complex interplay among malaria, SCD, autoimmune hemolytic anemia, and various treatments. Furthermore, the case highlights challenges related to managing severe malaria in non-endemic countries and underscores the importance of timely malaria testing, especially in vulnerable patients with a suitable travel history. A thorough travel history is essential for the early diagnosis and appropriate management of malaria. Heightened awareness is needed among both high-risk travelers and healthcare providers to reduce malaria-related morbidity and mortality.