From sixty-four percent hyperparasitemia to recovery: Managing severe falciparum malaria and delayed hemolytic anemia.

Severe Plasmodium falciparum malaria with hyperparasitemia is a life-threatening condition requiring urgent intervention, particularly in non-immune individuals. Artesunate has revolutionized its management, though complications such as post-artesunate delayed hemolysis (PADH) necessitate ongoing vigilance. We report a case of a 26-year-old sailor with a history of recent travel to Nigeria who presented to an Irish hospital with severe falciparum malaria and hyperparasitemia of 64.35%. Initial management included intravenous artesunate, continuous renal replacement therapy, and hemodynamic support, leading to rapid parasite clearance and recovery from multi-organ dysfunction. However, 1 week post-discharge, the patient developed PADH, manifesting as severe anemia requiring blood transfusion. This case underscores the importance of prompt diagnosis, rapid parasite clearance with artesunate, and multidisciplinary supportive care in severe malaria. Furthermore, the occurrence of PADH highlights the need for structured post-treatment follow-up, particularly in non-endemic regions where clinicians may be unfamiliar with such complications. Severe falciparum malaria requires urgent and aggressive management. While artesunate is life-saving, its delayed complications necessitate systematic monitoring. This case highlights the importance of integrating acute care with vigilant follow-up to optimize outcomes in severe malaria, especially in non-immune individuals with hyperparasitemia.