Primaquine-Induced Hemoglobinuria: A Case Report of a G6PD Deficient Malaria Patient with Mahidol Trait from Bandarban, Bangladesh

Md Fahad Zamil ¹ Ching Swe Phru ¹ Anamul Hasan ¹ Afrida Tabassum Trina ¹ Mohammad Shahbaz ² Shahrear Tanvir Ahmed ³ Mohammad Sharif Hossain ¹ Mohammad Shafiul Alam ^1*

• ¹ International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
• ² Ministry of Health and Family Welfare, Dhaka, Dhaka, Bangladesh
• ³ Directorate General of Health Services (Bangladesh), Dhaka, Dhaka, Bangladesh

We report a case of Primaquine (PQ) induced hemoglobinuria in a patient having glucose-6phosphate dehydrogenase (G6PD) Mahidol variant from Bandarban, Bangladesh. The patient presented with mixed Plasmodium falciparum and Plasmodium vivax malaria and was advised treatment according to national guidelines with Artemether-Lumefantrine for three days and PQ for 14 days. Ten days later, the patient developed a fever and jaundice, followed by hemoglobinuria twelve days after the initial diagnosis. That highlights the need for G6PD testing, which was subsequently confirmed through both Point-of-Care (POC) testing and spectrophotometry. The POC test showed a G6PD activity of 2.6 IU/g Hb, while spectrophotometry measured 1.47 IU/g Hb, both indicating G6PD deficiency (<30% activity). As a result, PQ was discontinued, and the patient received four units of blood transfusion. Additionally, genotyping was carried out, confirming the Mahidol variant. This case highlights the importance of routine G6PD screening before PQ administration, especially in malaria-endemic regions with diverse G6PD variants.