An unusual presentation of Plasmodium spp. in peripheral blood smear

A 7-year-old boy presented to the paediatric out-patient department with complaints of abdominal pain and fever for the past 6–7 days. On clinical examination, the child was febrile, with no evidence of hepatosplenomegaly. He was admitted for further evaluation and management and was started on intravenous ceftriaxone, paracetamol, pantoprazole, and Ringer lactate. Baseline laboratory investigations revealed normocytic, normochromic red blood cells with leukocytosis and a left shift, along with the presence of a few activated lymphocytes. The total leukocyte count was 16.3 × 10³/µL. Haemoglobin level was 9.2 g/dL, and the platelet count was markedly reduced at 35,000/µL. Inflammatory markers were significantly elevated, with a C-reactive protein (CRP) level of 144.8 mg/L. Liver function tests were within normal limits. Peripheral blood smear examination was performed in view of thrombocytopenia and persistent fever, which revealed unusual microscopic findings. These findings and their clinical significance are discussed below.