Worldwide Malarial infection remains a major cause for morbidity and mortality. Only 50-70% patients showed classic presentation of malaria with paroxysms of fever and rest unusual presentation might be because of impending resistance to antimalarial drugs and judicious use of antimalarial drugs and establishment of immunity. Here, we report peadiatric age group case of Vivax malaria with unusual presentation with history of generalized weakness with severe anemia and going for renal failure. He presented to emergency ward with failure to thrive and treatment started for nephrotic syndrome apparently no improvement in the patient. During laboratory investigation, found to be having malarial parasites in peripheral blood smear, for which immediate therapy was started. After first dose of antimalarial drug patient started showing some signs of recovery. Thus we would like to highlight atypical presentation of malaria, where early recognizing with treatment can save lives. Clinicians must be aware of unusual presentations and constant changes in epidemiology; difficulties in early detecting of severe manifestations of Plasmodium vivax malaria, emphasis must be made to lower the disease burden. Key words: P.vivax, anemia, malaria.