Publication: Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury
1
Issued Date
2015
Valid Date
2017-01-09
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
Malaria Journal. Vol.14, (2015), 246
Suggested Citation
Katherine Plewes, Haider, Md Shafiul, Kingston, Hugh W F, Yeo, Tsin W, Aniruddha Ghose, Hossain, Md Amir, Dondorp, Arjen M, Turner, Gareth D H, Anstey, Nicholas M Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury. Malaria Journal. Vol.14, (2015), 246. doi:10.1186/s12936-015-0760-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/3090
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Title
Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury
Abstract
Background: Severe falciparum malaria may be complicated by haemolysis after parasite clearance, however the
mechanisms remain unclear. Recent reports describe a pattern of delayed onset haemolysis among non-immune
travellers with hyperparasitaemia treated with intravenous artesunate, termed post-artesunate delayed haemolysis
(PADH). The occurrence and clinical impact of PADH following severe malaria infections in areas of unstable transmission
are unknown.
Case: A 45-year-old Bangladeshi male was initially admitted to a local hospital with severe falciparum malaria complicated
by hyperparasitaemia and treated with intravenous artesunate. Twenty days from his first presentation he was
readmitted with delayed onset haemolytic anaemia and acute kidney injury. Multiple blood transfusions and haemodialysis
were required. Renal biopsy revealed acute tubular injury and haem pigment nephropathy. His haemoglobin
and renal function recovered to baseline after 62 days from his second admission.
Discussion: This case highlights the differential diagnosis of post-malaria delayed onset haemolysis, including the
recently described syndrome of post-artemisinin delayed haemolysis. The pathophysiology contributing to acute
kidney injury in this patient and the limited treatment options are discussed.
Conclusions: This report describes PADH complicated by acute kidney injury in an adult patient living in a malaria
hypoendemic region who subsequently required blood transfusions and haemodialysis. This case emphasizes the
importance of routine follow up of haemoglobin and renal function in artesunate-treated patients who have recovered
from severe malaria.