Emergency Liver Transplantation in Amodiaquine-Induced Fulminant Hepatitis

Amodiaquine is an amino-4-quinoline with the basic spectrum of activity of chloroquine. It has been used widely to treat and prevent malaria. From the mid-1980s, there were reports of fatal adverse drug reactions described in travelers using amodiaquine as antimalarial prophylaxis. In 1990, the World Health Organization (WHO) stopped using this drug in malaria control programs. The WHO Expert Committee on Malaria modified this in 1993 and reported that amodiaquine could be used for treatment if the risk of infection outweighs the potential for adverse drug reactions. Currently, amodiaquine is a potential useful drug, especially if used with artemisinin-based combination therapy and with sulfadoxine-pyrimethamine to improve treatment efficacy for chloroquine-resistant strains of Plasmodium falciparum and P. vivax. We report a case of fulminant hepatitis induced by antimalarial prophylactic use of amodiaquine that necessitated emergency orthotopic liver transplantation.