a Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
b Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
c Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Plasmodium vivax is traditionally regarded as a cause of benign malaria; however, severe manifestations, including acute respiratory distress syndrome (ARDS), are increasingly recognized. Respiratory complications may occur at presentation or paradoxically worsen after initiation of antimalarial therapy, posing diagnostic and therapeutic challenges. We report a 41-year-old Indonesian man with no significant comorbidities who developed fever with a tertian pattern and progressive dyspnea following travel to an endemic region. Microscopic examination confirmed P. vivax infection with low parasitemia (250/µL). Despite early administration of dihydroartemisinin–piperaquine and primaquine, his respiratory status deteriorated on day four of hospitalization, accompanied by new bilateral patchy infiltrates on chest radiograph and a PaO₂/FiO₂ ratio of 247 mmHg, fulfilling criteria for mild ARDS. Blood and sputum cultures were negative, and no alternative cause of pneumonia was identified. Concomitant anemia, thrombocytopenia, and mild transaminitis suggested a systemic inflammatory response rather than a coincidental bacterial infection. The patient improved gradually with supportive oxygen therapy and completed antimalarial treatment, with subsequent parasitological clearance and resolution of symptoms. This case highlights that P. vivax malaria can be complicated by ARDS even in the setting of low parasitemia. Respiratory worsening after antimalarial initiation should raise suspicion for inflammatory lung injury rather than treatment failure or secondary infection. Early recognition and supportive management are crucial to prevent progression to severe respiratory compromise.
Keywords: Plasmodium vivax malaria; acute respiratory distress syndrome; malaria complications; severe vivax.
How to cite this article: Airlangga MM, Rusli M, Bramantono B. Plasmodium Vivax Malaria Complicated by Acute Respiratory Distress Syndrome: A Case Report. Int J Drug Deliv Technol. 2026;16(5): 170-176. DOI: 10.25258/ijddt.16.5.19
Source of support: Nil.
Conflict of interest: None