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Case Reports
. 2010 Aug;66(8):811-2.
doi: 10.1007/s00228-010-0824-3. Epub 2010 Apr 21.

Pancytopenia due to proguanil toxicity in a returning traveller with fever

Hetty Jolink  1 , Jan den Hartigh, Leo G Visser, Cees van Nieuwkoop
Affiliations
Case Reports

Pancytopenia due to proguanil toxicity in a returning traveller with fever

Hetty Jolink et al. Eur J Clin Pharmacol. 2010 Aug.

Abstract

A patient known to have renal insufficiency was admitted to the hospital with fever and pancytopenia after returning from a trip to Mali. Pancytopenia was not caused by a tropical infection but was a side effect of atovaquone/proguanil used as malaria chemoprophylaxis. High and prolonged detectable proguanil serum levels can result in bone marrow suppression in patients with renal insufficiency. This should be taken into account in a returning traveller with fever and pancytopenia.

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Figures

Fig. 1
Fig. 1
Elimination curve of proguanil levels in the patient compared to elimination curve of healthy subjects [1]. Extensive metabolizers have normal metabolic capacity of CYP2C19, a key enzyme involved in the metabolization of proguanil to cycloguanil. Poor metabolizers have decreased metabolic capacity of CYP2C19. The expected elimination curve of the patient would be between the curves of poor and extensive metabolizers, but because of impaired excretion due to renal insufficiency the elimination curve is shifted to the right. T = 0: time of last tablet of atovaquone/proguanil
See this image and copyright information in PMC

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