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.