Work

Delayed hemolytic anemia after artemether-lumefantrine in Plasmodium falciparum malaria: A case report

Year: 2025

Type: article

Abstract: Delayed hemolytic anemia (DHA) is a rare, severe complication of artemisinin-based therapies. We report a case of DHA following an extended course of oral artemether-lumefantrine (AL) in a 50-year-old male with follicular lymphoma treated with rituximab 10 months ago and severe Plasmodium falciparum malaria (parasitemia >10%). The patient developed significant hemolysis eight days post-treatment. Laboratory findings were consistent with DHA, including reticulocytosis and, notably, a positive direct Coombs test. The patient's underlying immunosuppression, pre-existing hepatosplenomegaly, and the prolonged AL regimen likely contributed to the severity. The positive Coombs test suggests a possible immune-mediated component, differentiating it from the typical non-immune mechanism. This case highlights that DHA can occur after oral AL, not just intravenous artesunate, and underscores the critical need for vigilant post-treatment monitoring (2-4 weeks) of hemoglobin in high-risk patients with comorbidities or high parasite burdens.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2025.108304

Authors: Oğuz Usta, Deniz Güllü, Özlem Alhan, Önder Ergönül

Institution: Koç University

Language: English

Topic: Malaria Research and Control

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,900