Erythema multiforme and Malarone?

摘要

We wish to highlight a rare but severe cutaneous drug reaction to malaria prophylaxis which, to our knowledge, has been reported only once before in the literature. A 72 year old female presented to the accident and emergency department with a 5 day history of widespread rash associated with fever, sore throat and oral mucosal erosions. One day previously she had returned from a week's holiday in Kenya. There had been an insidious onset of rash and systemic upset while abroad. As recommended by current guidelines from the Health Protection Agency and advice from a local NHS travel clinic, malaria prophylaxis was taken in the form of Malarone~R (Proguanil 100 mg and Atovaquone 250 mg once daily) for 1 week prior to departure and throughout the holiday. The rash had developed after 9 days of taking this medication. There was no significant past medical history, no other regular or new medications, and no history of insect bites while on holiday.