A 46-year-old man with stable HIV and hepatitis C virus chronic infection was seen for unexplained fever, headache, and vomiting after a trip to Cameroon. There were no significant physical findings. Complete blood count showed marked thrombocytopenia (28 × 109/L) and normal white blood cell count and hemoglobin. Examination of the peripheral blood smear showed severe Plasmodium falciparum infection (parasitemia 1% and 1 schizont). In addition, there were numerous examples of hemophagocytosis on the peripheral blood smear. The top left panel shows a monocyte with particulate debris, perhaps remnants of the malarial infection. The top right panel shows a red cell engulfed by a monocyte. On the bottom left, the phagocytosed material resembles a platelet, and on the bottom right is a larger, circular, phagocytosed object that may represent an erythroblast nucleus or a giant platelet. Additional laboratory tests included triglycerides 5.29mM, ferritin 897 µg/L, and lactic dehydrogenase 278