An Unexpected Cause of Thrombocytopenia in Pregnancy: A Case of Malaria in a Non-endemic Setting With Unclear Transmission Source.

Malaria remains a significant global health threat, with increasing concern for imported and locally acquired cases in non-endemic regions. We present the case of a 35-year-old pregnant woman from Sierra Leone, living in Missouri, who despite no recent international travel, was found to have symptomatic Plasmodium falciparum malaria. Her clinical course was notable for fever, severe thrombocytopenia, mild anemia and intraerythrocytic ring forms on her peripheral smear. She had a history of chronic hepatitis B and prior chemotherapy for Hodgkin lymphoma and recent travel to Florida, where local malaria transmission has been documented. The patient responded rapidly to artemisinin-based therapy, with resolution of parasitemia and improvement in hematologic parameters. This case highlights the diagnostic challenges of malaria in pregnancy, particularly in non-endemic settings and draws attention to the evolving epidemiology of malaria and the need for vigilance in regions previously considered malaria-free.