Recurrent Plasmodium falciparum Malaria after Delayed Hemolysis Induced by Artemether–Lumefantrine

Although artemether-lumefantrine is a first-line treatment for uncomplicated Plasmodium falciparum (P. falciparum) malaria, delayed hemolysis may occur after therapy. A previously healthy 39-year-old Japanese man developed P. falciparum malaria after traveling to Togo and was treated with artemether-lumefantrine in the Philippines. Because fever and fatigue persisted after treatment, he presented to the study hospital and was diagnosed with delayed hemolysis induced by artemether-lumefantrine. Supportive therapy, including blood transfusion, led to symptomatic improvement, and he was discharged. However, he was subsequently readmitted because of recrudescence of P. falciparum malaria accompanied by hemolytic anemia. Treatment with atovaquone-proguanil resulted in clinical improvement. Because delayed hemolysis and recrudescence may develop after treatment of P. falciparum malaria with artemether-lumefantrine, careful follow-up for at least 4 weeks after treatment with artemether-lumefantrine should be considered.