LAUSR

A 63-year-old man presented to an Accident and Emergency department (located in an affluent part of central London) on a Saturday morning with abdominal pain, fever, diarrhea, and vomiting following a buffet meal. He had a background of type II diabetes mellitus. Platelets were noted to be 21 × 10 9 /l on admission, hemoglobin concentration was 148 g/l and the white cell count was 5.1 × 10 9 /l. Renal function was normal. He was treated for gastroenteritis, but his clinical condition deteriorated rapidly and he was noted to be more confused with a Glasgow Coma Scale of 11/15 . He was also hypotensive and tachycardic. The clinical team contacted the hematology team on the Monday morning for approval of a platelet transfusion to cover a femoral line insertion. A blood film had previously been made but not looked at. The blood film, now examined, showed reactive lymphocytes and heavy parasitemia with Plasmodium falciparum (images). He was transferred to the intensive care unit and started on artemether and lumefantrine with good clinical effect. He continued to improve, was extubated 2 days later, and was discharged from hospital 4 days later with a platelet count of 366 × 10 9 /l.