Autochthonous Plasmodium falciparum malaria in a high-altitude, non-endemic region of Ethiopia: a case report.

BACKGROUND: Malaria transmission in Ethiopia is traditionally limited to altitudes below 2000 m. Debark Town, situated at 2850 m, is a high-altitude highland fringe area characterized by a cold climate and has historically been considered a non-endemic zone. This report describes a rare, locally acquired case of Plasmodium falciparum in this extreme environment. CASE PRESENTATION: A 15-year-old Ethiopian female of Amhara ethnicity resident in Debark Town presented with a 5-day history of high-grade fever (39.5 °C), headache, and vomiting. Significantly, she reported no history of travel to known malaria-endemic regions. Clinical examination revealed tachycardia (140 bpm) and hypotension (90/50 mmHg). Laboratory investigations showed profound thrombocytopenia (20 × 109/L). P. falciparum infection was confirmed via a rapid diagnostic test (RDT) and thick blood smear (0.14% parasitemia). Despite the hypotension and low platelet count, the patient remained alert and was classified as having high risk but uncomplicated malaria. MANAGEMENT AND OUTCOME: The patient was treated with a weight-based, six-dose regimen of Artemether-Lumefantrine (ACT) and supportive fluid resuscitation. Rapid clinical response was observed; apyrexia was achieved within 24 h. A follow-up assessment at 1 week confirmed full clinical and hematological recovery with negative parasitology. CONCLUSIONS: This case highlights the shifting epidemiology of malaria in the Ethiopian highlands, where traditional "altitude barriers" may no longer provide absolute protection. Clinicians in high-altitude zones must maintain a high index of clinical suspicion for malaria in febrile patients, regardless of travel history, to ensure early diagnosis and prevent severe outcomes in non-immune populations.