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LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 10  |  Page : 3454-3455  

Chloroquine induced utricaria—A detailed history helps


1 Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India
2 Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India

Date of Submission29-Aug-2019
Date of Decision16-Sep-2019
Date of Acceptance17-Sep-2019
Date of Web Publication31-Oct-2019

Correspondence Address:
Dr. Pugazhenthan Thangaraju
Assistant Professor, Department of Pharmacology, All India Institutes of Medical Sciences (AIIMS), Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_712_19

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How to cite this article:
Thangaraju P, Venkatesan S, Prakash M. Chloroquine induced utricaria—A detailed history helps. J Family Med Prim Care 2019;8:3454-5

How to cite this URL:
Thangaraju P, Venkatesan S, Prakash M. Chloroquine induced utricaria—A detailed history helps. J Family Med Prim Care [serial online] 2019 [cited 2019 Nov 21];8:3454-5. Available from: http://www.jfmpc.com/text.asp?2019/8/10/3454/270024



Sir,

We read with great interest a case report Chloroquine induced utricaria: A newer adverse effect by Balamurugesan, et al.[1] The authors have reported a case of young male diagnosed with malaria that developed utricaria. The appearance of utricaria was immediate after taking the first dose of Chloroquine. Here we add one more case who is a young boy developed utricaria after the first dose of Chloroquine.[2] This will further add in gaining further knowledge.

In addition, some important points in relation to this case and with the available literature on malaria and utricaria were detailed out. Since malaria is endemic in India, it is important always to make a good interpretation so that it will help the community in mass. Since Chloroquine is extensively used antimalarial drug, we should be cautious in all aspects of medication. So, in view of the important facts we made our search and found there are reports on malaria and utricaria that is highly needed to be discussed to come up with interpretation of the disease and drug [Table 1].
Table 1: Case report and studies of utricaria in malaria

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The literature shows an incidence of malarial disease manifesting with urticaria was reported between 1.33 and 25.6%.[6],[7],[8] Several reports are seen from India.[9],[10] Natarajan et al. postulated that deposition of malarial pigment in the reticuloendothelial system (RES) produces excessive IgE that triggers urticaria.[11] This presentation may also occur with a wide range of subclinical infection. A report of urticarioid manifested case with imported pernicious cerebral malaria was documented.[12] Talib et al. presented cases of malaria for their protean manifestations. In five patients out of thirteen presented for chronic urticaria with or without polyarticular arthritis and few other mimicked acute rheumatic arthritis with a case of pulmonary tuberculosis and two other developed apparent Chloroquine-resistant malaria.[13]

Hence, in an endemic area like India, the presentation of fever and urticaria should always give physicians and health care professionals a clue of underlying timely treatable malaria.

With this background and since drug is involved, we did a Naranjo probability scale and found to be scored “3” and shows the “possibility” only [Table 2].
Table 2: Naranjo probability scale

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Regarding the case we feel strongly that the patient history in the past regarding any urticarial rash with fever might be advantageous to know. Also, if it is Chloroquine induced, the alternative drug used should be detailed out.

To conclude, we the physicians at the primary health care should be aware of both the aspects that will help us in decision making and to prevent untoward adverse reaction. It is also our mandate to notify the national pharmacovigilance program of India (PVPI) through respective ADR monitoring center or by mobile application.

Financial support and sponsorship

Nil.

Conflict of interest

There is no conflict of interest.



 
  References Top

1.
Balamurugesan K, Davis P, Ponprabha R, Sarasveni M. Chloroquine induced urticaria: A newer adverse effect. J Family Med Prim Care 2019;8:2545-7.  Back to cited text no. 1
  [Full text]  
2.
Ould Ahmedou Salem MS, Mohamed Lemine YO, Deida JM, Lemrabott MA, Ouldabdallahi M, Ba MD, et al. Efficacy of chloroquine for the treatment of Plasmodium vivax in the Saharan zone in Mauritania Malar J 2015;14:39.  Back to cited text no. 2
    
3.
Sharma V, Singhal M, Sharma A, Kumar V. Febrile urticaria in a family: Uncommon manifestation of a common disease. J Infect Dev Ctries 2012;6:895-6.  Back to cited text no. 3
    
4.
Vaishnani JB. Cutaneous findings in five cases of malaria. Indian J Dermatol Venereol Leprol 2011;77:110.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Godse KV, Zawar V. Malaria presenting as urticaria. Indian J Dermatol 2012;57:237-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Mehta SR, Joshi V, Lazar AI. Unusual acute and chronic complications of malaria. J Assoc Physicians India 1996;44:451-3.  Back to cited text no. 6
    
7.
Deb T, Mohanty RK, Ravi K, Bhagat BM. Atypical presentations of falciparum malaria. J Assoc Physicians India 1992;40:381-4.  Back to cited text no. 7
    
8.
Mishra SK, Satpathy R, Das DB, Nanda NC, Satpathy SK, Mohanty S. A rare presentation of falciparum malaria. J Assoc Physicians India 1995;43:582.  Back to cited text no. 8
    
9.
Mitra A. Malaria presenting with urticaria as the initial feature. Indian Pediatr 1989;26:728.  Back to cited text no. 9
    
10.
Maheshwari N, Maheshwari V, Mobashir M. Plasmodium vivax malaria presenting with urticaria. Postgrad Med J 1989;65:266-7.  Back to cited text no. 10
    
11.
Natarajan C. Malarial urticaria: A study of 12 cases. In: Jain SK, editor. Aspects of Allergy and Applied Immunology XIII-XIV, 1980-1. Delhi: VP Chest Institute; 1980. p. 86-7.  Back to cited text no. 11
    
12.
Loschiavo F, Ventura-Spagnolo T, Di Bella P, Bramanti P. Urticarioid manifestation in course of cerebral imported malaria. Acta Neurol (Napoli) 1993;15:211-4.  Back to cited text no. 12
    
13.
Talib SH, Gaikwad A, Jirwankar PS. Protean manifestations of malaria (multi-organ dysfunction syndrome) Indian J Pathol Microbiol 1996;39:473-6.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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