[Two cases of fulminant hepatitis during a curative treatment with an artesunate-amodiaquine combination].

Two previously healthy young women presented with a lethal hepatitis a few days after the onset of an artesunate-amodiaquine combination at the recommended doses for a bout of fever. Nothing proved the fever was due to malaria, the toxic cause of hepatitis, or to the drugs used. Imputability was based on chronology (fever, drug combination, sudden onset of severe fatigue, hepatitis lethal in a few days) and on the absence of any other evident cause for hepatitis. Severe hepatitis under prolonged amodiaquine treatment has been reported since 1985, the risk is estimated at 1/15500 treatments and the symptoms usually appear within 10 to 160 days. The current international recommendations are to promptly treat uncomplicated malaria access, with an artemisinin-based combination therapy, especially with artesunate-amodiaquine. The risk of iterative amodiaquine use could be the same as prolonged treatments, given that the suspected toxicity mechanisms are metabolite accumulation or an immunoallergic phenomenon. All adverse effects must be reported.