To the editor: Italian colleagues describe two recent cases of probable autochthonous-introduced Plasmodium vivax malaria, suggesting that sporadic cases may be considered possible in areas with vector abundance and favourable environmental conditions [1]. Nevertheless, we have some concerns about this report: firstly, no other concurrent P. vivax malaria cases have been reported in the Pontine marshes or in the Calabria Region; secondly, no secondary cases have been reported to arise from the index cases; thirdly, the first patient visited Santo Domingo in the Dominican Republic in 2003, an area where malaria cases still occur; fourthly, as previously affirmed in a publication by the same group about an unusual case of late relapse of P. vivax four years after the acute infection [2], at least the first case could be explained as a late relapse following an asymptomatic or paucisymptomatic primary infection. In conclusion, the described cases could in our opinion be viewed as probable imported, and not autochthonous, P. vivax cases.