Recurrent Plasmodium falciparum Malaria after Delayed Hemolysis Induced by Artemether-Lumefantrine.
Kosuke Asano, Tokio Hoshina, Tomomi Miyamoto et al.
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Case in brief
A previously healthy 39-year-old Japanese man developed Plasmodium falciparum malaria after travel to Togo and received artemether-lumefantrine in the Philippines. Persistent fever and fatigue led to hospital assessment, where delayed hemolysis attributed to treatment was diagnosed. He improved with supportive care, including transfusion, but was later readmitted with malaria recrudescence and hemolytic anemia. Atovaquone-proguanil treatment was followed by clinical improvement.
What made this case unusual
Delayed hemolysis after artemether-lumefantrine was followed by recrudescent P. falciparum malaria with hemolytic anemia, linking two post-treatment complications in one patient.
Diagnostic / clinical pearl
Persistent or recurrent symptoms after artemether-lumefantrine warrant assessment for both delayed hemolysis and recrudescent malaria.
Why it matters
The authors suggest considering careful follow-up for at least 4 weeks after artemether-lumefantrine treatment.