Background Immunity to malaria is complex, due to the replicative cycle of the parasite through intracellular and extracellular phases. Cellular and humoral immunity are necessary to contain the infection; it is more complicated in patients who regular receive immunosuppressive treatment.

Purpose To report a case of malaria after recent kidney transplantation without recent exposure to an endemic area.

Material and methods The patient was a 42-year-old man who presented to the hospital after 2 days of nausea, vomiting, fever, headache and malaise. He was from Nigeria and had lived in Spain since 2004. His medical history was significant for renal transplantation from a live donor a month before this episode. Regarding the donor, the 58-year-old man was HLA identical with normal examination results, including PCR negative for Leishmania spp and Plasmodium spp. Blood smears were negative. Concerning his medical history, he had malarial disease 6 years previously.

Results Haemogram showed normal range levels except for lower platelet count and increased serum creatinine. Blood smears demonstrated Plasmodium falciparum and parasitaemia at 1%. Blood was sent to the laboratory for PCR confirmation. The patient was started on treatment with Quinimax (a combination of four alkaloids related to quinine) and doxycycline adjusted dose, for 7 days. This treatment required special follow-up for glycaemia. Also, renal function was monitored and immunosuppressive drug levels (tacrolimus–prednisolone) were measured, owing to interaction with malaria drug treatment. Dose adjustment was required. No parasitaemia was found after malaria treatment. The patient was discharged with follow-up appointments.

Conclusion To date, there are some cases of malaria after kidney transplantation with unknown origin; it could be considered a recrudescence years after exposure. In conclusion, routine malaria pro­phylaxis treatment is likely necessary for renal transplantation and in the post-transplantation period for patients from endemic areas although they do not have to have had recent contact, especially if the donor is also from an endemic areas.

No conflict of interest