Fever of unknown origin in pregnancy: the need for a full history.

A 26-year-old woman with 29 weeks gestation presented with headache, photophobia and fever. She had deranged liver function tests and low platelets on admission. Blood film, performed to look for haemolysis, revealed she had Plasmodium vivax malaria, despite not having travelled to an endemic malaria area for over 1 year. The diagnosis was confirmed on PCR test performed in the HPA malaria reference laboratory in London and she was treated with chloroquine. She delivered a healthy baby at 33+3 weeks gestation, and once the patient and the baby had both tested negative for glucose-6-phospate dehydrogenase deficiency, she was given primaquine to clear the hypnozoite phase in the liver. This case highlights the importance of an extended travel history in a patient with fever of unknown origin and the difficulties of treating non-falciparum malaria in pregnancy.