Background <p>Wolff-Parkinson-White (WPW) syndrome is a congenital abnormality of the cardiac conduction system characterized by the presence of an accessory pathway, which can predispose affected individuals to supraventricular tachycardia (SVT), atrial fibrillation, ventricular fibrillation, and sudden cardiac death. Despite its clinical significance, WPW syndrome is often underdiagnosed, particularly in resource-limited settings where cardiac arrhythmias may be misattributed to other conditions.</p> Case presentation <p>We report an eight-year-old Nigerian girl with WPW syndrome who was repeatedly misdiagnosed and managed for malaria over four years before an accurate diagnosis was established. She presented with recurrent episodes of chest discomfort, generalized weakness, nausea, and near-syncope. Each episode was treated as malaria, and symptoms resolved following treatment. During the most recent episode of the symptoms, she received care in a tertiary centre where SVT was identified following an electrocardiogram (ECG), heart rate was persistently about 250 beats per minute. Initial pharmacologic intervention with intravenous amiodarone was ineffective, necessitating external cardioversion to restore normal sinus rhythm. A post-recovery ECG confirmed a Wolf Parkinson White pattern.</p> Conclusion <p>WPW syndrome remains a diagnostic challenge in paediatric populations, where it can masquerade varying diseases, resulting in misdiagnosis. This case underscores the importance of a high index of suspicion for cardiac arrhythmias in children presenting with unexplained recurrent symptoms. Early recognition and appropriate intervention are crucial in preventing life-threatening complications associated with WPW syndrome. Increased awareness among healthcare providers can lead to improved diagnostic accuracy and better patient outcomes.</p>