Intravenous Artesunate Treatment of Severe Malaria in a Patient With Systemic Lupus Erythematosus: A Case of Post-Artesunate Delayed Hemolysis

Systemic lupus erythematosus (SLE) is an autoimmune condition linked to multi-organ damage, and its correlation with malaria has been theorized. This case report details a 14-year-old Sudanese girl diagnosed with SLE and severe malaria who experienced hemolytic anemia following intravenous artesunate treatment. Intravenous artesunate was administered as the recommended treatment for severe malaria for one week and led to prolonged hemolysis with low hemoglobin levels and elevated lactate dehydrogenase activity; over three weeks, the hemolysis gradually subsided. This case highlights the need to consider post-artesunate (or artemisinin) delayed hemolysis (PADH) as a potential complication among patients receiving artemisinin derivatives for malaria treatment, thus necessitating enhanced surveillance strategies and further investigation of its mechanisms to optimize clinical practice and patient outcomes in this population.