Recrudescence of plasmodium falciparum malaria in a patient with progressive sarcoidosis

Although endemic malaria has largely been eradicated in the United States, cases still occur, often as a result of travel-related exposure. Although nearly all cases of Plasmodium falciparum malaria occur within 3 months of exposure, in rare instances, symptoms manifest years after the sentinel infection because of compromise of immunity and parasite recrudescence. We describe a case of a 49-year-old woman with a history of childhood malaria and no recent travel history who presented with P. falciparum malaria in the setting of progressing pulmonary sarcoidosis. This case report highlights the role of advancing immune compromise status in malarial recrudescence. We also consider other potential avenues to explain how a patient might develop P. falciparum malaria in a nonendemic region in the absence of recent travel.