title: An imported case of severe falciparum malaria with prolonged hemolytic anemia clinically mimicking a coinfection with babesiosis.
abstract: While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Na
authors.affiliation: Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
authors.forename: Jong-Yil
authors.initials: JY
authors.lastname: Chai
authors.affiliation: Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
authors.forename: Bong-Kwang
authors.initials: BK
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Je
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul 136-705, Korea.
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use; D000077332:Artesunate; D053626:Atovaquone / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D001404:Babesiosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D001541:Benin; D001769:Blood / Q000469:parasitology; D060085:Coinfection / Q000175:diagnosis / Q000473:pathology; D004338:Drug Combinations; D005602:France; D006801:Humans; D007723:Korea; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D002727:Proguanil / Q000627:therapeutic use; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D000077332:Artesunate; D017963:Azithromycin; D002727:Proguanil; D053626:Atovaquone
keywords: Plasmodium falciparum; artesunate; babesiosis; falciparum malaria; hemolytic anemia; imported malaria