A Case of Mefloquine-resistant Plasmodium falciparum Malaria with Convulsion after Antimalarial Treatment

Abstract

We report a case of 40-year-old with chloroquine- and mefloquine-resistant Plasmodium falciparum. He had a single grand mal seizure 37 days following retreatment with quinine intravenously, which resulted in rapid clearance of fever and parasitemia, in addition to mefloquine. He had a long history of seizures, which were well controlled by phenytoin. Because he has never had such a seizure before and computerized tomographic scanning of the brain after admission showed no abnormal findings which caused convulsions, it seemed to be an adverse reaction caused by antimalarial drugs. It is possible that a double or triple combination treatment for the emergence of multiresistant falciparum malaria might more frequently produce severe side effects, such as psychiatric reactions and convulsions. This case suggests that physicians must have a long follow-up period for chronic toxicity of antimalarial drugs, especially after using drug combinations for falciparum malaria.