Objectives Malaria is an acute and chronic protozoan illness characterised by fever, chills, sweats, fatigue, anaemia and splenomegaly. It is caused by intracellular Plasmodium protozoa transmitted to humans by female anopheles mosquitoes. Four species of Plasmodium cause malaria in humans: P falciparum, P vivax, P ovale and P malariae. The principal areas of transmission are Africa, Asia and South America.

Methods Infection caused by P falciparum is potentially fatal and is associated with more intense parasitaemia.

Results A 4-year-old girl came to our emergency department with high fever (38°C), prostration and refusal to eat, with an evolution of 48 h. She had arrived from Angola one week before. On clinical examination she presented with diastolic hypotension. There were no alterations in the consciousness level or neurological abnormalities. Blood examination revealed anaemia (haemoglobin 7.8 g/dl) and thrombocytopenia (plaques 41 × 10⁹/l) and alterations on the coagulation test. P falciparum was identified on thick blood smear, with 70% parasitaemia. She was admitted to the paediatric intensive care unit (PICU) and started antimalaria treatment with intravenous quinine and clindamicine. She also needed vitamin K, blood and plasma transfusions. During admission she did not present with any other complications and was discharged from the PICU with a parasitaemia <0.5%.

Conclusions With this case the authors wish to alert to a very frequent disease in underdeveloped countries, but very rare in Europe, with serious complications. This is a particular case because of the very intense parasitaemia.