Mefloquine adverse effects with atypical facial lesions in an overweight patient.
BACKGROUND
The recommended dosage of mefloquine to treat Plasmodium falciparum infection is 25 mg/kg, with no recommendation for dosage exceeding 1500 mg. We describe an original case of adverse reaction to mefloquine in an overweight patient.


METHODS
Case report.


RESULTS
A 32-year-old woman weighing 139 kg presented with uncomplicated P. falciparum infection after returning from Cameroon. She received 3250 mg of mefloquine (i.e. 23 mg/kg) administered in four doses. On day 2, she developed neuropsychiatric disorders and facial lesions. Nasal mucocutaneous vesicles and bullae, depressive mood, mild thrombocytopenia and hepatic cytolysis were evidenced. Parasitemia was negative. Recovery was complete on day 17. High mefloquine serum levels were measured (8.030 mg/L on day 3, 6.880 mg/L on day 8, and 3.370 mg/L on day 17).


CONCLUSIONS
The causal relationship between mefloquine and the occurrence of these adverse effects is probable. However, as no viral or bacteriological investigations were performed, the drug responsibility remains uncertain. Mefloquine-induced bullous and facial lesions reversible upon drug withdrawal have already been described. The associated neuropsychiatric symptoms were strongly suggestive of mefloquine adverse effects, as such events are more frequently observed in cases of overdosage. Our case emphasizes the difficulties of dosage adaptation in overweight patients.
Service Parasitoses digestives et cutanées, Sérologies parasitaires-Toxoplasmose, Hôpital de la Croix Rousse, Université Claude Bernard Lyon 1, France.
Elodie
E
Descloux
Frédérique
F
De Monbrison
Cécile
C
Basselin
Thierry
T
Vial
François
F
Peyron
D000328:Adult; D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D001768:Blister / Q000139:chemically induced*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D015767:Mefloquine / Q000009:adverse effects* / Q000627:therapeutic use; D009666:Nose / Q000473:pathology*; D050177:Overweight
D000962:Antimalarials; D015767:Mefloquine