A 25-year-old male patient, resident in the province of Buenos Aires, diagnosed with autism after three months of a trip to the Amazon region of Bolivia, Peru, Ecuador and Brazil, treated with mefloquine in another institution.
The patient did not return to an endemic area.
Three months after completing the treatment she consulted in our Service for fever and headache of two days of evolution.
Physical examination revealed a body weight of 72 kg, generalized stiffness and mild enlargement.
Laboratory tests showed leukocytosis of 14,300/mm3 with a preserved leukocyte formula, platelets 84,000/mm3.
Renal and hepatic function was normal.
A peripheral blood smear (PSF) was performed to detect parasites compatible with P. vivax, with a Pmia < 2%.
The diagnosis was carried out in the Rehabilitation Unit of "Francisco J. Muñiz" Infectious Diseases Hospital.
She was treated with chloroquine (CQ) 1,500 mg of total dose, with clinical remission and negative parasitemia at 48 h.
The glucose-6-phosphate dehydrogenase level was 266 mg/dl (normal range), so she received PQ 15 mg/day for 15 days, with good adherence.
Control parasitemias were performed in the first and fourth week after treatment resulting negative.
Subsequently, she presented two new episodes of P. vivax relapse.
Seven months later she presented with a four-day fever associated with chills, holocrane headache, arthralgias and abdominal pain.
Physical examination revealed pale skin and mucous membranes, jaundice in the conjunctiva and petechiae in the lower limbs.
Laboratory tests showed normal blood count and platelet count, and bilirubin of 2.5 mg/dl predominantly indirect.
The FSP reported parasitemia < 2%.
Treatment was completed with CQ 1,500 mg total dose and PQ 30 mg daily for 15 days, with good adherence and negative parasitemia at four weeks.
Five months later she consulted for intermittent fever of two days duration associated with headache and asthenia.
Physical examination and laboratory did not show any pathological findings.
Parasitemia < 2% was found.
The same scheme was initiated with good adherence and negative parasitemia at four weeks.
There were no new relapses during the 15 months of follow-up.
