Severe Allergic Reaction to Oral Artesunate-Amodiaquine Combination Treatment for Malaria: Case Report in the Democratic Republic of Congo

Abstract

Background: In 2012-2013, a pilot study on implementation of community-based case malaria management by trained community health workers was implemented in southern Katanga Province in the Democratic Republic of Congo (DRC). We report one case of severe adverse reaction that was linked to artesunate-amodiaquine (ASAQ). Case summary: An apparent healthy, 15-year-old Congolese female with a positive rapid diagnostic test for Plasmodium falciparum without any sign of complications was prescribed a fixed dose combination of ASAQ. Under direct observation, she took two tablets of ASAQ (200 mg AS/540mg AQ total) with water. Approximately 30 minutes later, she developed a generalized pruritus and widespread urticarial rash, with marked periorbital and forearm swelling. She was immediately referred to the nearest clinic. She did not present with fever or any respiratory distress and was fully conscious. She received dexamethasone 8 mg IV, followed 20 min later by 4 mg of chlorphenamine orally. Approximately 40 minutes after, the rash and swellings had mostly resolved. She received oral quinine as a second line treatment. Conclusion: This single presentation was the only such occurrence from 1354 malaria-infected patients. As ASAQ is the most widely used first-line treatment in the DRC, increased awareness and close monitoring of the use of this drug are advised. Health care professionals should document, report and provide immediate medical assistance.