Abstract:
A case of an acute reversible visual loss in a 10-yearold
child who was on mefloquine prophylaxis, and was
treated with artesunate-amodiaquine for an acute febrile
illness diagnosed clinically as uncomplicated malaria,
is reported. On admission the patient could not
perceive light and had bilateral papilloedema. She was
treated with dexamethasone and recovered her sight
gradually over a 21-day period. There has been no previous
report to our knowledge, of an association between
acute visual loss and mefloquine, amodiaquine,
or artesunate in the published literature, even though
mefloquine is associated with blurring of vision, and
antimalarials of the quinoline class have been associated
with retinopathy (during long term use). While causality
is difficult to ascribe in this case, it may be prudent
to avoid the use of quinoline-based antimalarials
for treating acute malaria in travelers taking mefloquine
prophylaxis, because information on the safety of
concurrent use of artemisinin combination therapies
and mefloquine, or other recommended prophylactic
regimens, is limited.