Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 1 2017 08 26 5 8 EN Fereshteh Ghiasvand Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamid Emadi-Kuchak Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohamadreza Salehi Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2017 01 28 2017 06 07 Thrombocytopenia during the clinical course of Plasmodium falciparum malaria has been reported in different studies. However, for Plasmodium vivax malaria, profound thrombocytopenia (i.e., a platelet count below 20,000/µl), is infrequent. In this paper, we want to report of a case of vivax malaria with very severe thrombocytopenia. A 16-year-old man was examined in the emergency department because of fever, epistaxis, and very severe thrombocytopenia. In his phosphate-buffered saline evaluation, malaria vivax was confirmed. Artesunate because of severe malaria was begun. The fever was stopped after 24 hours. The last platelets count was 185,000, and the patient was discharged with good condition. In conclusion, very severe thrombocytopenia as a complication of P. vivax malaria is rare; however, it may be manifested by the skin and mucous membrane bleeding and result in more severe complications, therefore prompt antimalarial treatment may lead to satisfactory outcome. https://crcp.tums.ac.ir/index.php/crcp/article/view/102 https://crcp.tums.ac.ir/index.php/crcp/article/download/102/65