title: Pancytopenia due to proguanil toxicity in a returning traveller with fever.
abstract: A patient known to have renal insufficiency was admitted to the hospital with fever and pancytopenia after returning from a trip to Mali. Pancytopenia was not caused by a tropical infection but was a side effect of atovaquone/proguanil used as malaria chemoprophylaxis. High and prolonged detectable proguanil serum levels can result in bone marrow suppression in patients with renal insufficiency. This should be taken into account in a returning traveller with fever and pancytopenia.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands. h.jolink@lumc.nl
authors.forename: Hetty
authors.initials: H
authors.lastname: Jolink
authors.forename: Jan
authors.initials: J
authors.lastname: den Hartigh
authors.forename: Leo G
authors.initials: LG
authors.lastname: Visser
authors.forename: Cees
authors.initials: C
authors.lastname: van Nieuwkoop
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use / Q000633:toxicity*; D005260:Female; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008302:Mali; D008875:Middle Aged; D009426:Netherlands; D010198:Pancytopenia / Q000139:chemically induced* / Q000188:drug therapy; D002727:Proguanil / Q000627:therapeutic use / Q000633:toxicity*; D014195:Travel
chemical_list: D000962:Antimalarials; D002727:Proguanil
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