Abstract
Introduction:Chloroquine is one of the most used drugs in the world used for the prophylaxis and treatment of malaria and other clinical conditions.Case report:This index case with no psychiatric morbidity had presented with emergent mania following choloroquine use for amoebic liver abscess with dramatic resolution of symptoms following withdrawal of offending drug and short course of SDA.Discussion:About 10 case reports of chloroquine induced mania reported till date. Chloroquine has large volume of distribution of >100 L/kg leading to high tissue concentrations with brain concentrations 10–30 times higher than plasma. It is neurotoxic to dopamine neurons leading to hyperdopaminergic state. Also acts as NMDA agonist and GABA antagonist leading to excessive NMDA excitotoxicity with GABAergic inhibition. Treatment protocol includes withdrawal of drug, administration of antipsychotics and acidification of the urine to improve renal clearance.Conclusion:Chloroquine continues to be widely prescribed drug. It may be avoided if the patient has a psychiatric history. Knowledge of psychiatric side effects enables prompt detection and appropriate management.
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