Malaria mimicking acute appendicitis in an Ethiopian child: a case report

Abstract Background: Malaria remains a major public health problem both globally and in Ethiopia. It is caused by five species of Plasmodium : P. falciparum , P. vivax , P. ovale , P. malariae , and P. knowlesi . Clinical manifestations range from mild illness to severe, complicated disease. This case highlights that malaria can present with features mimicking appendicitis, emphasizing the need to consider preoperative malaria testing, particularly in endemic regions. Case Presentation: An 8-year-old Ethiopian boy presented with classic signs of acute appendicitis, without abdominal distension and with normal passage of stool and flatus. On examination, he appeared ill and febrile, with right lower quadrant tenderness and no organomegaly. Routine laboratory investigations were unremarkable. Based on these findings, a diagnosis of acute appendicitis was made, and the patient underwent an appendectomy after completing preoperative preparations. Intraoperatively, the appendix appeared normal. Postoperatively, the fever persisted, prompting a rapid diagnostic test for malaria, which was positive for Plasmodium falciparum and confirmed by peripheral blood film examination. Antimalarial therapy was initiated according to national guidelines, leading to marked clinical improvement. The patient was discharged on the fourth postoperative day in good condition. Conclusion A febrile child from a malaria-endemic area presenting with abdominal pain and clinical signs suggestive of appendicitis should first be evaluated for malaria before any surgical intervention. Early malaria testing may help avoid unnecessary surgery and guide appropriate treatment. Further research is needed to better understand and confirm whether a true causal relationship exists between malaria and appendicitis.