A 25-year-old Indian man from Mumbai presented 5 months after arrival in Singapore in 2013 with fever and myalgia for 5 days. Physical examination was unremarkable. Laboratory investigation showed total white cell count 5.21 × 109/L (3.4-9.6 × 109/L), hemoglobin 13.9 g/dL (12.9-17.0 g/dL), platelets 24 × 109/L (132-372 × 109/L), neutrophils 88.9%, lymphocytes 6.3%, and eosinophils 0%. The renal and liver function tests were normal. Malaria microscopy revealed trophozoites of Plasmodium vivax (parasite load of 0.40%). He was treated with chloroquine and 14 days of primaquine for eradication of hypnozoites. A repeat peripheral blood smear after treatment revealed eradication of malaria parasites but the presence of another parasite measuring 250 µm in length as shown in the figure.
He was diagnosed with microfilaremia (Wuchereria bancrofti). He was treated with 1 dose of ivermectin (12 mg) and doxycycline (100 mg) twice a day for 6 weeks. He returned to India and was lost to follow-up.
