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• W2977978334 abstract "After a thorough evaluation of the literature, we report the first fulminant hepatic failure (FHF) requiring orthotopic liver transplantation (OLT) as a possible life-threatening reaction to Malarone®. Malarone® is a fixed combination of atovaquone with proguanil which is an effective treatment and prophylaxis of multi-drug resistant Plasmodium falciparum. Atovaquone and proguanil (paludrine), which is not available in the United States except in Malarone®, both can cause hepatitis even when given alone. This report should remind physicians of the severity of adverse reactions associated with antimalarial medication. We describe a 56-year-old female with Hashimoto's disease and medically untreated hyperlipidemia with no previous hospitalizations or liver disease. A week prior to traveling to India for a month, she initiated antimalarial medication using Malarone®. She remained asymptomatic while on the medication in India and continued to ingest the medication for another week after returning home. After completing the course of prophylaxis, she developed nausea, vomiting and diarrhea. This was followed by intermittent fevers. She finally was admitted to her local hospital after becoming jaundiced. Initial laboratory blood work revealed transaminases in excess of 2000. Complete liver serological work-up was negative. Panculture was also negative. Abdominal CT, ultrasound and HIDA scan failed to show an etiology for her hepatitis. The patient's transaminases improved daily but her bilirubin and protime slowly increased. Because of the fear of imminent hepatic failure, the patient was transferred to the Cleveland Clinic. Although the patient's transaminases improved, she continued to have worsening hyper-bilirubinemia and coagulopathy. She remained pan-culture negative despite spikes in body temperature. While at the Cleveland Clinic, she underwent a complete OLT evaluation and liver biopsy. The liver biopsy showed acute fulminant hepatitis with submassive necrosis, and the pattern of injury identified, in combination with the onset of failure in relation to antimalarial medication, strongly implicated a drug or toxin-induced hepatitis. After a brief interlude of improvement, the patient became encephalopathic with de-compensated synthetic liver function. She was immediately listed for OLT and was the recipient of a donor liver shortly thereafter. She has done well post-operatively." @default.
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• W2977978334 date "2004-10-01" @default.
• W2977978334 modified "2023-09-26" @default.
• W2977978334 title "FULMINANT HEPATIC FAILURE REQUIRING ORTHOTOPIC LIVER TRANSPLANTATION ASSOCIATED WITH MALARONE® ANTIMALARIAL PROPHYLAXIS" @default.
• W2977978334 doi "https://doi.org/10.14309/00000434-200410001-00617" @default.
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