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A Journal on Internal Medicine

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Panminerva Medica 1998 December;40(4):345-6

language: English

Mefloquine-­induced ­grand mal sei­zure in tuber­cu­lar men­in­gi­tis

Bregani E. R., Tien T. V., Figini G.

From the Division of Emergency Medicine, Ospedale Maggiore ­IRCCS, Milan, Italy


Mefloquine rep­re­sents a prom­is­ing anti­ma­lar­ial ­drug ­against Plasmodium fal­cip­ar­um. It has ­been relat­ed to an ­increase in sei­zure fre­quen­cy in epi­lep­tic ­patients and ­should not be admin­is­tered to ­patients ­with a his­to­ry of con­vul­sions, epi­lep­sy in ­first ­degree rel­a­tives, or seri­ous psy­chi­at­ric dis­or­ders. We ­report a ­case of a man ­from the Ivory Coast com­plain­ing of ­fever, head­ache and ane­mia treat­ed ­with chlo­ro­quine and sub­se­quent­ly ­with mef­lo­quine in the sus­pi­cion of malar­ia, ­even in the ­absence of labor­a­to­ry con­fir­ma­tion. When the ­patient ­came to our divi­sion, malar­ia was exclud­ed, but the ­patient devel­oped two con­vul­sive epi­sodes, respec­tive­ly 4 and 7 ­days ­after the inges­tion of the sec­ond ther­a­peu­tic ­dose of mef­lo­quine. Further inves­ti­ga­tion was per­formed; par­tic­u­lar­ly an EEG ­showed abnor­mal­ities com­pat­ible ­with ten­den­cy for sei­zures, dif­fuse ­waves and ­spikes. CSF cul­ture was pos­i­tive for M. tuber­cu­lo­sis as ­well as ­urine, spu­tum and ­blood cul­tures. Anti-HIV anti­bod­ies ­were pos­i­tive, so the ­final diag­no­sis was tuber­cu­lo­sis in HIV infec­tion. As sei­zures are com­mon ­signs of cere­bral tuber­cu­lo­mas, but not of men­in­gi­tis it is pos­sible ­that tuber­cu­lar men­in­gi­tis ­might ­have ­enhanced ­severe neu­ro­psy­chi­at­ric ­side ­effects of mef­lo­quine. Physicians ­should be ­aware ­that treat­ment ­with mef­lo­quine ­with con­com­i­tant men­in­gi­tis ­could ­have a ­risk of devel­ope­ment of ­grand mal sei­zure.

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