Severe hypersensitivity reaction as acute eosinophilic pneumonia and skin eruption induced by proguanil

Abstract

To the Editors: The combination of atovaquone and proguanil is effective and safe in the prevention and treatment of malaria. We present the first report of proguanil-induced acute eosinophilic pneumonia (AEP) associated with skin eruption. On December 18, 2006, a 40-yr-old female was admitted to our hospital (Victor Provo Medical Centre, Roubaix, France) for shortness of breath and widespread skin lesions. She had a 10-pack-yr smoking history but no respiratory illness or relevant comorbidity. On the morning of December 8, 2006, she had initiated atovaquone–proguanil treatment for malaria prophylaxis prior to a trip to Senegal. She had taken the same treatment for the first time 1 yr previously without any complications. That evening she developed progressive dyspnoea with nonproductive cough and subacute fever (38°C). She only stayed in Senegal for 4 days and did not leave her hotel room during this time. After returning to France she continued to take atovaquone–proguanil for 1 week. Increased shortness of breath prompted her to consult her general practitioner, who prescribed amoxicillin plus clavulanic acid for bronchitis. This treatment was withdrawn on the day 4 because of rapidly spreading skin eruptions on day 3. Although …