Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 10 ( 2018 ) > List of Articles

CASE REPORT

Artesunate-induced severe autoimmune hemolytic anemia in complicated malaria

Bhaskar Shahbabu, Ajai Tentu, Anshu Kumar

Keywords : Anemia, artesunate, autoimmune hemolytic anemia, hemolytic, malaria

Citation Information : Shahbabu B, Tentu A, Kumar A. Artesunate-induced severe autoimmune hemolytic anemia in complicated malaria. Indian J Crit Care Med 2018; 22 (10):753-756.

DOI: 10.4103/ijccm.IJCCM_298_18

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Autoimmune hemolytic anemia (AIHA) is a very rare cause of anemia in a case of malaria and drug-induced AIHA is even rarer. A 50-year old patient with a history of fever for 8 days was diagnosed with a case of complicated malaria with mixed infection having initial parasite index of 45%. He showed good response on initial therapy with artesunate (parasite count reduced to <1%) but his haemoglobin (Hb) continued to drop from 12 g% to 4.9 g% over a course of 11 days. Direct coombs test was positive with reduced haptoglobin and increased lactate dehydrogenase suggesting AIHA. The patient was put on steroids and transfused with saline washed O-negative blood. He gradually recovered over 8 weeks with Hb level rising up to 12 g%. This is a rare case of AIHA following treatment of severe malaria with parenteral artesunate suggesting of the drug immune-related mechanism.


PDF Share
  1. Acharya S, Verma A, Singh D, Gupta V, Mahajan S. A case of Plasmodium vivax malaria associated with severe autoimmune hemolytic anaemia. Ann Trop Med Public Health 2012;5:133.
  2. Böttiger L, Westerholm B. Acquired haemolytic anaemia. Acta Med Scand 2009;193:223-6.
  3. Askling HH, Bruneel F, Burchard G, Castelli F, Chiodini PL, Grobusch MP, et al. Management of imported malaria in Europe. Malar J 2012;11:328.
  4. Dondorp A, Nosten F, Stepniewska K, Day N, White N; South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) group. Artesunate versus quinine for treatment of severe falciparum malaria: A randomised trial. Lancet 2005;366:717-25.
  5. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): An open-label, randomised trial. Lancet 2010;376:1647-57.
  6. Zoller T, Junghanss T, Kapaun A, Gjorup I, Richter J, Hugo-Persson M, et al. Intravenous artesunate for severe malaria in travelers, Europe. Emerg Infect Dis 2011;17:771-7.
  7. Kreeftmeijer-Vegter AR, van Genderen PJ, Visser LG, Bierman WF, Clerinx J, van Veldhuizen CK, et al. Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium. Malar J 2012;11:102.
  8. Rolling T, Schmiedel S, Wichmann D, Wittkopf D, Burchard GD, Cramer JP, et al. Post-treatment haemolysis in severe imported malaria after intravenous artesunate: Case report of three patients with hyperparasitaemia. Malar J 2012;11:169.
  9. Kano S. Artemisinin-based combination therapies and their introduction in Japan. J Infect Chemother 2010;16:375-82.
  10. Caramello P, Balbiano R, De Blasi T, Chiriotto M, Deagostini M, Calleri G. Severe malaria, artesunate and haemolysis. J Antimicrob Chemother 2012;67:2053-4.
  11. Roberts DJ, Casals-Pascual C, Weatherall DJ. The clinical and pathophysiological features of malarial anaemia. Curr Top Microbiol Immunol 2005;295:137-67.
  12. Raffray L, Receveur MC, Beguet M, Lauroua P, Pistone T, Malvy D. Severe delayed autoimmune haemolytic anaemia following artesunate administration in severe malaria: A case report. Malar J 2014;13:398.
  13. Lee S, Lee S, Chung B, Hwang T, Shin H. A case of Plasmodium vivax malaria associated with autoimmune hemolytic anemia. Infect Chemother 2008;40:63.
  14. Drouin J, Rock G, Jolly EE. Plasmodium falciparum malaria mimicking autoimmune hemolytic anemia during pregnancy. Can Med Assoc J 1985;132:265-7.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.