PMC5496505_01
Peripheral blood film showing PF ring forms (Arrow).
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An urgent blood smear showed ring forms of P. falciparum (PF) with a parasitaemia of 1.3% (Fig. 1).
A. A PA CXR on admission to the hospital. B. PA CXR 2 weeks following admission. C. CT scan of the chest 2 weeks following admission.
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Two weeks later he continued to worsen with fever, had worsening infiltrates on CXR (Fig. 2A and B), and there was difficulty in weaning him off the ventilator. A CT scan of the chest showed bilateral pleural effusion, airspace shadowing (consolidation) and ground-glass appearance involving both lungs (Fig. 2C).
Haemotoxylin and eosin (H&E) stain of lung tissue showing diffuse moderate thickening of the alveolar walls  with fibroblastic plugs in both alveolar spaces and bronchioles (black arrow), and marked intra-alveolar accumulation of histiocytes .
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The features were consistent with the resolving phase of ARDS or cryptogenic organising pneumonia (Fig. 3).
PMC5496505_02
AP CXR 3 days after admission showing extensive bilateral airspace disease.
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A CXR displayed extensive bilateral shadowing consistent with pulmonary oedema or ARDS (Fig. 4).
PMC5496505_03
Blood film for malaria showing high degree PF parasitaemia.
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The initial blood investigations revealed a WBC of 9.9 x 109/L, platelets 12 x 109/L, and a peripheral blood film showed PF ring forms >5% (Fig. 5).
PA CXR 3 days after admission.
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An initially normal CXR showed bilateral infiltrates more visible on the left lung (Fig. 6).