A 13-year-old adolescent daughter of a missionary presented with fever and jaundice 1 week after returning from Africa. Examination of peripheral blood film revealed the diagnosis of Plasmodium falciparum infection. Therapy with oral quinine and doxycycline was curative. Diagnosis requires a travel history and a high index of suspicion. Because of the frequency of international travel, United States physicians need to be familiar with the presentation and management of imported P falciparum. Preparation for such travel must include careful counseling and optimal use of chemoprophylaxis.