title: Haemolytic anaemia in an HIV-infected patient with severe falciparum malaria after treatment with oral artemether-lumefantrine.
abstract: Intravenous (i.v.) artesunate is now the recommended first-line treatment of severe falciparum malaria in adults and children by WHO guidelines. Nevertheless, several cases of haemolytic anaemia due to i.v. artesunate treatment have been reported. This paper describes the case of an HIV-infected patient with severe falciparum malaria who was diagnosed with haemolytic anaemia after treatment with oral artemether-lumefantrine.The patient presented with fever, headache, and arthromyalgia after returning from Central African Republic where he had been working. The blood examination revealed acute renal failure, thrombocytopaenia and hypoxia. Blood for malaria parasites indicated hyperparasitaemia (6%) and Plasmodium falciparum infection was confirmed by nested-PCR. Severe malaria according to the laboratory WHO criteria was diagnosed. A treatment with quinine and doxycycline for the first 12 hours was initially administered, followed by arthemeter/lumefantrine (Riamet(®)) for a further three days. At day 10, a diagnosis of severe haemolytic anaemia was made (Hb 6.9 g/dl, LDH 2071 U/l). Hereditary and autoimmune disorders and other infections were excluded through bone marrow aspiration, total body TC scan and a wide panel of molecular and serologic assays. The patient was treated by transfusion of six units of packed blood red cell. He was discharged after complete remission at day 25. At present, the patient is in a good clinical condition and there is no evidence of haemolytic anaemia recurrence.This is the first report of haemolytic anaemia probably associated with oral artemether/lumefantrine. Further research is warranted to better define the adverse events occurring during combination therapy with artemisinin derivatives.
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, Italy. angela.corpolongo@inmi.it
authors.forename: Angela
authors.initials: A
authors.lastname: Corpolongo
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Nardo
authors.forename: Piero
authors.initials: P
authors.lastname: Ghirga
authors.forename: Elisa
authors.initials: E
authors.lastname: Gentilotti
authors.forename: Rita
authors.initials: R
authors.lastname: Bellagamba
authors.forename: Chiara
authors.initials: C
authors.lastname: Tommasi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Paglia
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.forename: Pasquale
authors.initials: P
authors.lastname: Narciso
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000503:physiopathology; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects*; D060085:Coinfection; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D004912:Erythrocytes / Q000187:drug effects; D004983:Ethanolamines / Q000008:administration & dosage / Q000009:adverse effects*; D005449:Fluorenes / Q000008:administration & dosage / Q000009:adverse effects*; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000821:virology; D006461:Hemolysis; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects / Q000502:physiology; D012720:Severity of Illness Index
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes