Jarisch–Herxheimer Reactions with artemether/lumefantrine: an uncommon side effect of anti-malarial medications
Year: 2024
Type: article
Study design: Case Report
Abstract: Background: The Jarisch–Herxheimer reaction (JHR) was a nonspecific adverse effect manifested by fever, chills, headache, myalgia, and exacerbations of skin rash that’s firstly described with anti-spirochetes medications and later with fluoroquinolones, cephalosporins, meropenem, and tetracyclines but not with antiparasitic drugs. Herein we reported JHR in a young Sudanese male due to antimalarial medications with good outcomes. Case Presentation: A 27-year-old Sudanese man presented with malaria-like symptoms and was given an oral artemisinin combination. However, within 8 h, the patient developed high-grade fever, chills, rigors, recurrence of the headache, tachycardia, myalgia, and tachypnoea, which was diagnosed as a JHR. The drug was temporarily stopped, the patient was hydrated, and an antipyretic was given, then the drug was restarted with a good response. Viral screening and syphilis tests were negative while blood tests showed leukocytosis, lymphopenia, and left shift in granulocytes. Discussion: In this case, the patient received Coartem 80/480 (artemether 80 mg/lumefantrine 480 mg). Eight hours after starting treatment, his fever dropped to 37.8°C, with other symptoms improving. Surprisingly at 8 h, the patient developed a second fever of 39.4°C, with chills, headache, tachycardia, a pulse rate of 103, myalgia, and hyperventilation. This is comparable with Koefoed’s case, where the patient received Fansidar (sulfadoxine/pyrimethamine). His JHR started 10 h later, indicated by the second rise in temperature. Conclusion: JHR can occur with antimalarial medications, most commonly by non-specific symptoms and worsening of pre-existing skin lesions; this requires a high clinical susceptibility, particularly within the first 24 h, with treatment discontinuation and hydration as the mainstay of management, with good outcomes.
Authors: Abdallah M. Abdallah, Khabab Abbasher Hussien Mohamed Ahmed, Malaz Tarig AbdAlla Mohamed, Imam B. Mohamed, Manasik M. El Murtada Mubarak Ismail, Hosham Mohammed Mosa Mohammed, Monzer Hassan Balla Mustafa, Abubaker Mustafa Abdalla Mustafa, Niam Adam Abubakr Mahdi, Mohammed Mahmmoud Fadelallah Eljack, Ghassan E. Mustafa Ahmed
Language: English
Topic: Malaria Research and Control
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4402214683