Artesunate-induced severe autoimmune hemolytic anemia in complicated malaria

Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu, Anshu Kumar, Bhaskar Shahbabu, Vani Singh, Nidhi SinghIndian Journal of Critical Care Medicine 2018 22(10):753-756Autoimmune 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.
Source: Indian Journal of Critical Care Medicine - Category: Intensive Care Authors: Source Type: research