Neurotoxicity Due to Antimalarial Therapy Associated with Misdiagnosis of Malaria

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Abstract
Sir—In support of recently published reports [1, 2], we present the case report of a patient who had neurotoxicity due to antimalarial therapy that was associated with misdiagnosis of malaria. A 39-year-old man sought medical attention at our clinic after returning to the United States from Sierra Leone. He reported tremors, a lack of coordination, an inability to concentrate, and severe anxiety after receiving five 10-day courses of artesunate therapy and one 10-day course of chloroquine therapy for the treatment of malaria during 3 separate episodes of fever, chills, and malaise. The patient received doxycycline therapy for malaria chemoprophylaxis and reported full adherence to treatment. A neurological examination demonstrated tremors, restlessness, hyperreflexia, and spasticity. The other findings of this examination were normal. The results of laboratory evaluations were also normal. The findings of a chest radiograph and an MRI of the brain were also reported to be normal. A serum specimen was analyzed by the indirect fluorescent antibody (IFA) method at the Centers for Disease Control and Prevention (Atlanta, GA) for detection of antibodies to all the human plasmodium species; all tests were reported to show a titer of <1 : 16 (consistent with no previous exposure to malaria). At subsequent evaluations after discontinuation of the antimalarial drugs, the patient's symptoms had improved markedly.

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