Introduction Plasmodium vivax was traditionally thought to be benign; however, nowadays it presents with a myriad of systemic complications like cerebral malaria, acute respiratory distress syndrome, acute kidney injury, acute pancreatitis, hepatic dysfunction, and disseminated intravascular coagulation, which were earlier attributed only to Plasmodium falciparum malaria. Here we report a case of a middle-aged man who presented with disseminated intravascular coagulation manifesting as symmetrical peripheral gangrene. What makes this case more interesting is that the malaria isolated was Plasmodium vivax instead of Plasmodium falciparum . Such findings were previously reported, but this is the first case where the patient was managed conservatively with antimalarial drugs without the need for amputation, which focuses on the very important role of early diagnosis and timely management. Case presentation A 44-year-old Indian man from north India presented with history of fever of 2 days’ duration with severely painful cold extremities. No pulse could be recorded on examination. A diagnosis of symmetrical peripheral gangrene was made. During the etiological evaluation, Plasmodium vivax malaria was found leading to disseminated intravascular coagulation causing this complication. He was started on artesunate and lumefantrine combination therapy and he recovered completely without the requirement of amputation. Conclusion This case highlights the non-benign nature of Plasmodium vivax and its emerging complications. Also it correlates symmetrical peripheral gangrene with Plasmodium vivax malaria. It also emphasizes the importance of timely diagnosis and intervention to reduce mortality and morbidity.

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Background: India bears a high burden of both dengue and malaria. An early distinction between the two could be invaluable in reducing mortality and morbidity. The objective of this study is to identify clinical, biochemical, and radiological parameters for the same, which could aid early detection and treatment of both diseases. Methods: A cross-sectional study was conducted at a tertiary care hospital in South Delhi, India. 100 pre-diagnosed patients each of dengue and malaria were studied. Features on clinical examination, and results of radiological and biochemical investigations were recorded. Continuous variables were compared using t-test, whereas categorical variables were subjected to chi-square test. P-value of ≤0.05 was taken as significant.Results: All patients presented with short pyrexia (fever < 7 days). Rash (27%), pruritus (28%), abdominal pain (30%) and breathlessness (20%) were significantly associated with dengue, whereas headache (99%) was significantly associated with malaria. Radiological investigations showed patients with dengue had pleural effusion (46%) and ascites (49%), and hepatosplenomegaly was more common in malaria (44%). Mean hemoglobin levels, and platelet counts were significantly lower in malaria (11.24 g/dL, and 62.07 × 10 3 /mm 3 respectively), than in dengue (13.03 g/dL, and 84.61 × 10 3 /mm 3 respectively). Liver enzymes showed rise in both diseases with a marked elevation in dengue. Raised serum bilirubin levels and mild renal dysfunction were both highly significant for malaria (P < 0.001). Conclusion:The study concludes that a distinction between dengue and malaria can be made on the basis of their clinical, radiological and biochemical findings.