Some atypical complications are not frequently described for malaria and likewise are not classically referred as severe malaria. Rhabdomyolysis has been reported for vivax in 1993 in a patient with myoadenylate deaminase deficiency [139] ; only one case was reported in Brazil in a patient without co-morbidities [46] . Rarely, patients with vivax malaria could evolve with immune thrombocytopenic purpura (ITP) as a complication of the acute infection [33] . To confirm this diagnosis, the patient has to be followed up with persistent thrombocytopaenia for many weeks after the efficacious anti-malarial treatment and diseases, in which ITP is more frequently seen, such as HIV, should be discarded. The mechanisms involved are poorly understood. Splenomegaly is considered a typical finding in the physical examination of a patient with vivax disease, but the occurrence of spleen haematomas evolving with rupture and fatal outcome is relatively rare [41, 52, 91] despite being more frequent among this species as compared to falciparum [140] . In any case, patients with vivax malaria referring abdominal pain should be investigated for this complication as some patients may evolve with a bad prognosis if not properly managed by a surgeon.