“…Because of the HLH syndrome's rarity, diversity, and complexity, diagnosis is difficult [1]. Malaria, a vector-borne disease caused by Plasmodium species is a rare cause of HLH, hence it is difficult to diagnose due to significant overlap in clinical features and laboratory findings between these two entities, which can be complicated by pre-existing paroxysmal cold hemoglobinuria (PCH) rarely found in the literature [2]. PCH is a type of autoimmune hemolytic anemia (AIHA) caused by atypical IgG autoantibodies that bind to their target RBC antigen and fix complement at 4 °C.…”