Abstract
Antimalarial medications carry a risk of rare, but serious side effects. Primaquine
in particular is known to cause methemoglobinemia and hemolytic anemia. In patients
with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency, these side effects
become amplified and can be life-threatening. This can complicate treatment plans
as the recommended first-line management of severe methemoglobinemia, methylene blue,
may cause or worsen hemolytic anemia in G6PD deficient patients. We present a case
of a toddler with an accidental primaquine overdose who had undiagnosed G6PD deficiency.
Over the 2 days following his ingestion he developed severe methemoglobinemia and
hemolytic anemia toxicity. He was initially treated with a dose of methylene blue
prior to learning of his G6PD deficiency. He was subsequently given additional doses
of ascorbic acid and a blood transfusion. His condition gradually improved and he
was ultimately discharged in good condition. To our knowledge, this case represents
a unique presentation of mixed methemoglobinemia and hemolytic toxicity due to an
accidental primaquine overdose in a G6PD deficient pediatric patient. Though cases
remain relatively rare, pediatric patients represent the vast majority of known primaquine
overdoses. Their diagnosis and treatment require maintaining a high index of suspicion
and a good working knowledge of antimalarial toxicities and management options.
Keywords
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Article Info
Publication History
Published online: November 19, 2020
Accepted:
October 21,
2020
Received in revised form:
October 5,
2020
Received:
August 2,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Inc. All rights reserved.
