A 65-year-old male missionary priest from Kenya presented with a history of fever, generalized fatigue, jaundice, and dark urine. On physical examination, he was found to be confused, tachycardic with a temperature of 101. Initial blood work revealed severe anemia, thrombocytopenia, and hyperbilirubinemia.

Examination of blood smears showed infestation with Plasmodium falciparum, with 90% of red cells containing as many as four parasites (small ring forms). In P. falciparum infection, the parasite is identified as a tiny ring form within normal sized erythrocytes. These ring forms often show double nuclei and "applique" morphology against the cytoplasmic membrane. Also shown is the classic boomerang, or banana-shaped, gametocyte. The patient was admitted to the medical intensive care unit and was treated appropriately with full supportive measures. Following a prolonged hospital course, the patient improved and was discharged.