Abstract
Intravascular hemolysis, particularly blackwater fever is a rare but severe clinical syndrome, occurring after ingestion of antimalarials. Diagnosis relies on clinical symptoms and on the color of the urines. A resurgence of this affection which occurred frequently during the colonization has lately been noticed. We report a case of blackwater fever complicated with severe renal failure and severe acute hemolysis having evolved favorably with modest resuscitation means. A 16 year teenager from Burkina Faso, who regularly takes quinine to treat malaria presumptive access, presented the waning of an undocumented malaria, fever, consciousness disorders, anemia, jaundice and blackish urine. The thick drop, blood cultures and urine cultures were negative. Biology revealed leukocytosis 14,000/mm<sup>3</sup>, anemia in 6.5 g/dL, total bilirubin 80 μmol/L and kidney failure at 13 mmol/L of azotemia and 700 μmol/L creatinine. The evolution was favorable after a modest resuscitation. Blackwater fever still exists in our daily practice. We need to think about in front of sudden onset of hemolysis and acute renal failure with dark-red colored urine during treatment of malaria. We are facing an issue thus a rational use of antimalarials is necessary.
Highlights
Blackwater fever (BWF) is a severe form of malaria characterized by the occurrence of acute intravascular hemolysis immediately associated with profound anemia
The diagnosis of BWF is based on fever, quinine taken before the event, hemoglobinuria and anemia
The World Health Organization (WHO) defines BWF as a pathological entity corresponding to severe intravascular hemolysis with a hemoglobinuria and profound anemia, associated with zero or low parasitaemia, occurring in a European expatriate living in endemic zone for several years and dealing improperly with quinine [13]
Summary
Blackwater fever (BWF) is a severe form of malaria characterized by the occurrence of acute intravascular hemolysis immediately associated with profound anemia. The disease was described almost exclusively among Europeans living in malaria endemic area and consuming, repeatedly and prolonged quinine for prophylaxis or curative purposes but irregularly or inadequate doses [1, 4]. It has been described with halofantrine and mefloquine [5, 6]. BWF realizes a table associating acute intravascular hemolysis, anemia, jaundice, hemoglobinuria and usually acute kidney failure that makes all its severity [8]. We report a case of severe hemolysis and BWF with severe acute kidney failure
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