Dr. Mefloquine‐Induced Eosinophilic Pneumonia

Abstract

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine-resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67-year-old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8-week trip to South Africa. A thorough work-up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine-induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.

Malaria Prophylaxis: A Comprehensive Review

“…Neuropsychiatric adverse events may occur during mefloquine chemoprophylaxis, from nightmares to psychosis, that might require prophylaxis interruption [41,69]. Usually, neuropsychiatric adverse effects occur after 2-3 doses, mostly in subjects with history of neuropsychiatric disturbances; such problems should carefully be ruled out before prescribing mefloquine [41].…”

“…Severe adverse events were reported by 11%, 12%, 6% and 7% in those travellers taking mefloquine, chloroquine/proguanil, doxycycline or atovaquone/proguanil respectively [53]. Among rarest adverse events, eosinophilic pneumonia in a woman [69] and one case of reversible tinnitus and hearing loss in a 67 years old women with history of broken tympanum in childhood [71] have been reported. Mefloquine adverse events may discourage travellers from the use of this effective drug, even if discordant evidence exists [48,72].…”