Artesunate is the standard treatment for severe malaria. Although clinical recovery is typically rapid, a delayed haemolytic reaction can appear 1–3 weeks later, often when the patient has transitioned back to primary care. Awareness in community settings is therefore crucial, especially in regions where malaria is uncommon.A 39-year-old man was treated with artesunate for severe Plasmodium falciparum malaria. He improved quickly and was discharged with stable haemoglobin. Two weeks later, he presented with fatigue, dark urine and jaundice. Tests showed severe anaemia, raised LDH, indirect hyperbilirubinaemia and low haptoglobin. The direct antiglobulin test (DAT) was weakly positive, creating uncertainty regarding autoimmune haemolysis. Further evaluation excluded G6PD deficiency, drug-induced causes, recurrent malaria and mechanical haemolysis. He was admitted and received transfusion. At six-week review, he was asymptomatic and the DAT had reverted to negative, indicating the initial weak result was likely a transient, infection-related false positive, while the overall pattern was consistent with post-artesunate delayed haemolysis (PADH).PADH is uncommon and often under-recognised in non-endemic settings. This case is notable for the initially weakly positive DAT, which later reverted to negative, adding diagnostic complexity and demonstrating the importance of interpreting results within clinical context. The delayed haemolysis pattern also reflects the mechanism of splenic “pitting”, where once-infected erythrocytes are cleared from circulation, leading to reduced red cell survivalPatients treated with artesunate should be advised about delayed haemolysis, and follow-up blood tests at 1–3 weeks can facilitate early detection. Understanding transient DAT positivity reduces the risk of incorrect autoimmune labelling.PADH typically presents 1–3 weeks after artesunate therapy with raised LDH, indirect hyperbilirubinaemia and low haptoglobin. The process involves splenic pitting of previously parasitised erythrocytes, explaining the predictable timing. Although DAT is usually negative, transient weak positivity may occur during infection and should be interpreted cautiously. Early recognition and shared follow-up between hospital and primary care are important as delayed haemolysis often emerges after discharge.Post-artesunate delayed haemolysis is an important clinical entity. Increased awareness and structured post-treatment monitoring can support earlier diagnosis and reduce complications, particularly in regions where severe malaria is infrequently encountered.