Blackwater fever following artemether-lumefantrine administration in children in a malaria holoendemic region: A case series

Abstract

Aim: Blackwater fever is one of the severe forms of malaria that is infrequently reported. The association of blackwater fever with quinine is supported by its disappearance following the replacement of quinine with chloroquine. However, there seems to be a resurgence with recently introduced artemisinin-based antimalarials. Case Presentation: This is a case series of four males aged 3 – 11 years who presented to our facility with features of intravascular hemolysis following the intake of appropriate doses of Artemether/Lumefantrine for malaria treatment. Two of the cases were transfused, and one had two sessions of hemodialysis, however, all recovered fully and remained stable during follow-up visits. Conclusion: These cases underscore the need for a high index of suspicion for early detection of blackwater fever while using Artemether/Lumefantrine and the need for more post-market surveillance of the drug.