Malaria diagnosis: still a challenge in non-endemic countries.

A 72-year-old, female, Greek patient presented to the Emergency Department of our hospital complaining of fever and fatigue. She also mentioned that she had recently returned from a trip to the Republic of Congo, Africa. Laboratory evaluation revealed pancytopenia, abnormal liver tests, elevated lactate dehydrogenase (LDH) and high inflammation markers (C-reactive protein and erythrocyte sedimentation rate). She was admitted for further investigation. Due to the recent trip to Congo, our differential diagnosis included malaria, which is endemic in the region. A search for characteristic forms of malaria parasite in thick drop and thin layer of peripheral blood with May-Grunwald/Giemsa stain was performed. Examination of thin layer revealed crescent elongate gametes (Fig. 1A–C) and red blood cells (RBC) with delicate ring form trophozoites. Some RBC were multipleinfected, or they had rings with double chromatin dots