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Pancytopenia due to proguanil toxicity in a returning traveller with fever.

Hetty Jolink, Jan den Hartigh, Leo G Visser, Cees van Nieuwkoop
European Journal of Clinical Pharmacology 2010 August
A patient known to have renal insufficiency was admitted to the hospital with fever and pancytopenia after returning from a trip to Mali. Pancytopenia was not caused by a tropical infection but was a side effect of atovaquone/proguanil used as malaria chemoprophylaxis. High and prolonged detectable proguanil serum levels can result in bone marrow suppression in patients with renal insufficiency. This should be taken into account in a returning traveller with fever and pancytopenia.

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