Case Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Jan 16, 2014; 2(1): 12-15
Published online Jan 16, 2014. doi: 10.12998/wjcc.v2.i1.12
Epilepsy triggered by mefloquine in an adult traveler to Uganda
Federico Gobbi, Andrea Rossanese, Dora Buonfrate, Andrea Angheben, Chiara Postiglione, Zeno Bisoffi
Federico Gobbi, Andrea Rossanese, Dora Buonfrate, Andrea Angheben, Zeno Bisoffi, Department of Tropical Diseases, Sacro Cuore-Don Calabria Hospital, 37024 Verona, Italy
Chiara Postiglione, Prevention Department, ULSS 20 Verona, 37122 Verona, Italy
Author contributions: Gobbi F wrote the manuscript; Rossanese A and Postiglione C managed the patient; Buonfrate D and Angheben A performed the literature search; Bisoffi Z revised the manuscript; all authors have read and approved the final version to be published.
Correspondence to: Federico Gobbi, MD, PhD, Department of Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Via Don A Sempreboni 5, Negrar, 37024 Verona, Italy. federico.gobbi@sacrocuore.it
Telephone: +39-45-6013563 Fax: +39-45-6013694
Received: September 25, 2013
Revised: November 7, 2013
Accepted: December 12, 2013
Published online: January 16, 2014
Abstract

We report a case of a traveler who visited Uganda for 8 d, and took mefloquine one tablet/week for malaria prophylaxis. After the second dose, he suffered from two episodes of loss of consciousness with seizures, therefore mefloquine was discontinued. During the flight back after full recovery, seizures reoccurred while he was on board, he was disembarked in Addis Ababa and then transferred to Nairobi. After repatriation to Italy, he experienced four other similar episodes. The patient was still on full dose anticonvulsant therapy one year and a half after, as any attempt at reduced dose was unsuccessful. Currently, three agents (mefloquine, atovaquone/proguanil, and doxycycline) are recommended for malaria chemoprophylaxis, with similar efficacy but different adverse event profiles, regimens, and prices. Considering that mefloquine is associated with a higher risk of neurologic and psychiatric adverse events than the alternative regimens, we suggest considering mefloquine as a second line choice after atovaquone/proguanil and doxycycline for short-term travelers.

Keywords: Mefloquine, Neuropsychiatric disorders, Epilepsy, Antimalarial chemoprophylaxis, Side effects

Core tip: We report a case of epilepsy due to mefloquine chemoprophylaxis. Considering that mefloquine is associated with a higher risk of neurologic and psychiatric adverse events than the alternative regimens, we suggest considering mefloquine as a second line choice after atovaquone/proguanil and doxycycline for short-term travelers.