Suspected Allergy to Artemether-Lumefantrine Treatment of Malaria

J Travel Med 2003; 10:303–305. In the past two decades, several new antimalarial drugs, such as sulfadoxine–pyrimethamine, mefloquine and halofantrine,have been introduced in the treatment of chloroquine-resistant Plasmodium falciparum malaria. These antimalarials were considered safe until widespread use led to the discovery of rare but severe adverse effects, and more restricted use. The Qinghaosu derivatives artemisinin, artesunate, artemether and arteether have become important additions to malaria treatment. Whereas these compounds have already been a mainstay of malaria treatment in Southeast Asia and China over the last 10 years, they are still relatively new in Africa. Qinghaosu drugs appear to be well tolerated by patients, although early clinical studies have been regarded by some authors as not stringent enough to meet the requirements of many national or international drugregulating agencies.1,2 In comparison to the wealth of knowledge about the adverse effects of classic antimalarials such as chloroquine and quinine,experience concerning the adverse effects of Qinghaosu derivatives is still somewhat limited. Although neuroand cardiotoxic effects have been seen in animals at high dosages, few side effects have been reported in humans.3–7 We would like to present a case of a suspected allergic reaction with angioedema to the combination of artemether and lumefantrine,which we recently experienced during the treatment of a patient with uncomplicated P. falciparum malaria in Yaoundé, Cameroon. To our knowledge, this is the first such case to be reported. Case Presentation