Malaria – Clinical Case 2

Which of the following is likely to lead to a diagnosis of complicated malaria in this patient?

This patient was commenced on IV artesunate with a good clinical response and was discharged after two weeks of hospitalisation. One week later, the patient represents to the Emergency Department with lethargy and shortness of breath. The patient is hemodynamically stable. Laboratory testing shows a haemoglobin of 50 g/dl (haemoglobin at the time of discharge was 98 g/dl); platelets and coagulation panel are within normal range. Thick films and antigen testing are negative.

Which of the following is the most likely cause of this patient’s representation?