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Anaemia constitutes one of the main clinical manifestations of severe falciparum malaria, interestingly, anaemia may also be due to Artesunate related drug toxicity. A 42-year-old male patient with complaints of fever, difficulty in speaking, loss of balance and light headedness is presented to the clinic, extensive work up leads to a diagnosis of severe malaria. Initial parasitaemia is 20%. Upon receiving the treatment which is Artesunate, the patient witnesses massive improvement in his condition and parasitaemia is cleared. However, seven days post treatment and discharge, he returns to the hospital with classical signs of severe anaemia. Several aetiologies are suspected in the differential diagnosis, such as autoimmune haemolytic anaemia; a complication of severe malaria, the possibility of hemophagocytic syndrome is also taken into consideration. However, the final diagnosis was given as post Artesunate delayed haemolysis.
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