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Background  Imported cases of multidrug resistant  Plasmodium falciparum  and treatment failure with artemisinin-based regimens, although rare, have been described also in Western countries and their management is often challenging. This is also due to an inadequate knowledge and implementation of health prevention measures.    Case report  A complex case of imported malaria caused by  Plasmodium vivax / P. falciparum  isolates in a patient who was not taking chemoprophylaxis while he was travelling in Cambodia is reported in this article. After failures of artemisinin-based and both oral and intravenous quinine-based regimens, a multidrug resistant  P. falciparum  was detected. The patient was successfully treated with atovaquone–proguanil.    Conclusions  This experience highlights the importance of a careful management that should be based not only on the most up-to-date guidelines, but also on the awareness of a rapidly evolving scenario.

An intricate case of multidrug resistant Plasmodium falciparum isolate imported from Cambodia