Dihydroartemisinin-piperaquine is a combination of dihydroartemisinin and piperaquine which is highly effective in the treatment of uncomplicated falciparum malaria. Its adverse effects are generally tolerable and temporary. Choreoathetosis, an involuntary movement disorder characterized by continuous irregular twisting of the body, is not a documented adverse effect of this medication.
A 41-year-old Cameroonian man of black African ethnicity was brought to our primary care hospital because over the previous 6 hours he had been experiencing involuntary twisting movements of his body and he no longer had control of his limbs. Earlier that day, he had been prescribed an appropriate dose of dihydroartemisinin-piperaquine in our hospital. The abnormal movements started approximately 3 hours after ingesting the first dose of the drug. The review of systems and his past history were unremarkable. On clinical examination, he was conscious and oriented but was unsteady and displayed continuous generalized irregular twisting movements combined with abrupt low amplitude flinging of his limbs. Dihydroartemisinin-piperaquine-induced generalized choreoathetosis was diagnosed. He was sedated with diazepam and dihydroartemisinin-piperaquine was discontinued. The antimalarial drug was substituted with artemether-lumefantrine combination. The clinical progress was good and he was discharged home after 72 hours. No further abnormalities were noted during 7 months of follow-up.
Although dihydroartemisinin-piperaquine is increasingly popular as a well-tolerated/efficacious antimalarial drug, clinicians must note the rare possibility of choreoathetosis as an adverse effect of this medication and educate patients accordingly.
Jankovic A, Lang AE. Diagnosis and assessment of Parkinson’s disease and other movement disorders. In: Daroff RB, Lankovic J, Mazziotta JC, Pomeroy SC, editors. Bradley’s Neurology in Clinical Practices. 7th ed. London: Elsevier; 2016. p. 223–49.
Piola P, Fogg C, Bajunirwe F, Biraro S, Grandesso F, Ruzagira E, Babigumira J, Kigozi I, Kiguli J, Kyomuhendo J, Ferrandini L, Taylor W, Checchi F, Guthmann JP. Supervised versus unsupervised intake of six-dose artemether-lumefantrine for treatment of acute uncomplicated Plasmodium falciparum malaria in Mbarara, Uganda: a randomised trial. Lancet. 2005;365:1467–73. CrossRefPubMed
World Health Organization. Malaria Policy Advisory Committee Meeting: The cardiotoxicity of antimalarials 2017. Geneva: World Health Organization; 2017.
Yavo W, Faye B, Kuete T, Djohan V, Oga SA, Kassi RR, Diata M, Ama MV, Tine R, N’diaye JL, Evi JB, Same-Ekobo A, Faye O, Koné M. Multricentric assessment of the efficacy and tolerability of dihydroartemisinin-piperaquine compared to artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa. Malar J. 2011;10:198. CrossRefPubMedPubMedCentral
World Health Organization. World malaria report 2008. Geneva: World health Organization; 2008. CrossRef
World Health Organization. Global Malaria Programme: Guidelines for treatment of malaria 2010. Geneva: World Health Organization; 2010.
Ogutu BR, Onyango KO, Koskei N, Omondi EK, Ongecha JM, Otieno GA, Obonyo C, Otieno L, Eyase F, Johnson JD, Omollo R, Perkins DJ, Akhwale W, Juma E. Efficacy and safety of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children aged less than five years: results of an open-label, randomized, single-centre study. Malar J. 2014;13:33. CrossRefPubMedPubMedCentral
Zhang KY, Zhou JX, Wu Z, Huang QL. Susceptibility of Plasmodium falciparum to chloroquine, piperaquine, amodiaquine, mefloquine and quinine with in vitro microtechnique in Hainan Island [in Chinese]. Chin J Parasitol Parasitic Dis. 1987;5:165–9.
Lan CX, Lin X, Huang ZS, Chen YS, Guo RN. In vivo sensitivity of Plasmodium falciparum to piperaquine phosphate assayed in Linshui and Baisha Counties, Hainan Province [in Chinese]. Chin J Parasitol Parasitic Dis. 1989;7:163–5.
Gargano N, Ubben D, Tommasini S, Bacchieri A, Corsi M, Bhattacharyya PC, Rao BHK, Dubashi N, Dev V, Ghosh SK, Kumar A, Srivastava B, Valecha N. Therapeutic efficacy and safety of dihydroartemisinin-piperaquine versus artesunate-mefloquine in uncomplicated Plasmodium falciparum malaria in India. Malar J. 2012;11:233. CrossRefPubMedPubMedCentral
- Choreoathetosis – an unusual adverse effect of dihydroartemisinin-piperaquine: a case report
Benjamin Momo Kadia
Armelle Corrine Gounoue Simo
- BioMed Central