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Case Reports in Infectious Diseases
Volume 2018, Article ID 9720823, 3 pages
Case Report

Relapsing Malaria: A Case Report of Primaquine Resistance

1Northeast Ohio Medical University, Rootstown, OH, USA
2Elmhurst Hospital Center, Elmhurst, NY, USA
3Mount Sinai School of Medicine, New York, NY, USA
4Kent State University, Kent, OH, USA

Correspondence should be addressed to Sunita Shakya; ude.tnek@2aykahss

Received 15 December 2017; Accepted 22 February 2018; Published 11 March 2018

Academic Editor: Stephen Patrick Kachur

Copyright © 2018 Christopher Dijanic et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Primaquine (an 8-aminoquinoline malarial therapy) is the only FDA-approved therapy to treat the hypnozoite stage of P. vivax. We think of relapse occurring because of parasitic resistance or poor compliance secondary to drug toxicities. However, in patients with repeated treatment failure, we must consider CYP-450 mutations affecting drug metabolism as an important cause of relapse. A 47-year-old man who travelled to a jungle in Venezuela was diagnosed with P. falciparum and P. vivax in July 2015. He was treated with seven rounds of primaquine-based therapy in the following year, all resulted in relapse without further exposure to endemic areas. On his eighth presentation, he was found to have CYP-4502D6 mutation that affected the metabolism and activation of primaquine. Thereafter, he was treated without relapse. Primaquine efficacy depends on many factors. Understanding the mechanism responsible for malaria relapse is paramount for successful treatment and reduction in morbidity and mortality. This case illustrates the importance of considering cytochrome mutations that affect drug efficacy in cases of relapsing malaria.