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Pulmonary involvement in malaria has been characterized by alveolar or interstitial edema and is usually fatal. A 31-year-old man developed bilateral pleural effusions in the course of falciparum malaria without any other evidence of pulmonary disease. In the absence of any other cause for the effusions, it was speculated that the pleural fluid accumulation was caused by plugging of small venous and lymphatic channels, thereby diminishing the absorption pressure at the visceral pleura. Increased capillary permeability may have been an additional factor in the formation of the effusions.