Eradication therapy in Plasmodium vivax in variants of glucose-6-phosphate dehydrogenase (G6PD) deficiency individuals remains a clinical challenge. We present a case of primaquine-induced methaemoglobinaemia and haemolytic anaemia in a patient with falsely normal qualitative G6PD result during initial presentation, which was complicated with clinical sequelae of thrombosis. Further investigations showed moderate degree of G6PD deficiency. Our patient responded well to vitamin C and a modified weekly regimen of primaquine with no evidence of malaria relapse.
AinoonO, YuYH, Amir MuhrizAL. Glucose-6-phosphate dehydrogenase (G6PD) variants in Malaysian Malays. Hum Mutat2003; 21:101.
6.
BainBJ, BatesI, LaffanMA. Dacie and Lewis Practical Haematology12th ed.Philadelphia, PA: Elsevier; 2017. pp.238–9.
7.
EziokwuAS, AngeliniD. New diagnosis of G6PD deficiency presenting as severe rhabdomyolysis. Cureus2018; 10: e2387.
8.
AshleyEA, RechtJ, WhiteNJ. Primaquine: the risks and the benefits. Malar J2014; 13:418.
9.
WhiteNJ. Determinants of relapse periodicity in plasmodium vivax malaria. Malaria J2011; 10:297.
10.
LeslieT, MayanI, MohammedN. A randomised trial of an eight-week, once weekly primaquine regimen to prevent relapse of plasmodium vivax in Northwest Frontier Province, Pakistan. PLoS One2008; 3: e2861.
11.
SoloveyA, KollanderR, ShetA. Endothelial cell expression of tissue factor in sickle mice is augmented by hypoxia/reoxygenation and inhibited by lovastatin. Blood2004; 104: 840–6.
12.
LiuC, ZhaoW, ChristGJ. Nitric oxide scavenging by red cell microparticles. Free Radic Biol Med2013; 65: 1164–73.
13.
L'AcquaC, HodE. New perspectives on the thrombotic complications of haemolysis. Br J Haematol2015; 168: 175–85.
14.
MansouriA, LurieAA. Concise review: methemoglobinemia. Am J Hemato11993; 42: 7–12.
