Successful Oral Antimalarial Therapy in A 14-Year-Old Child with Blackwater Fever: A Case in a Rural Area of Asmat Regency of Papua, Indonesia: Successful Oral Antimalarial in Blackwater Fever

BACKGROUND: Blackwater fever (BWF) is one of the severe forms of malaria manifested by hemoglobinuria that causes dark-colored urine, fever, anemia, jaundice and acute kidney injury. BWF is most commonly associated with Plasmodium falciparum infection and its treatment. Parenteral antimalarial therapy is recommended as the treatment of choice for BWF. Here we present the first case of successful oral antimalarial therapy in BWF to the best of our knowledge. CASE PRESENTATION: A 14-year-old boy was hospitalized with BWF as the primary diagnosis based on the presence of fever, jaundice and “coca-cola”-colored urine, along with laboratory results which showed Plasmodium falciparum infection, anemia, and impaired kidney function. Uncomplicated malaria manifestations had been appearing for seven days before admission, but the syndrome of BWF developed several hours following the first dose of dihydroartemisinin-piperaquine (DHP). Treatment with a 3-day course of DHP was continued because parenteral antimalarials were unavailable at that time. Remarkable improvements were seen following the second and third doses of DHP along with adequate supportive medical care. CONCLUSION: The unavailability of parenteral antimalarials makes oral antimalarials a possible alternative treatment for BWF. In addition, close monitoring and supportive medical care are critical in the treatment of BWF.