Tawau was the epicentre of malaria infections in the 1970-1990’s, when industrialisation swept across the state of Sabah, Malaysia. Since then, effective public health intervention, mainly the Malaria Elimination Programme, introduced in 1998, has seen the disease shrivel down into its final elimination phase. Here we retrospectively analyse the case of a 63 year old male with multiple comorbidities who had no exposure to localities with high risk of infection- thus raising the question regarding the means of transmission. Multiple interviews and an entomological survey were conducted to elucidate the possible mechanism of infection in this patient. Findings point to locally-transmitted malaria, likely introduced by a patient from an endemic region in Tawau. Transmission via this route is rare, and has never before been reported in our setting. This rare case highlights the need for constant vigilance in malaria control and elimination, especially when the target of country-wide elimination is close.