A report describes a case of a 40-year-old male patient who presented with a fever associated with vomiting and sudden onset of a consciousness disorder. He reported receiving malaria rapid diagnostic tests (RDT), with positive results reflecting the presence of Plasmodium falciparum antigen in the blood, a week ago. He also conveyed receiving an antimalarial treatment based on quinine injection at a rate of 25 mg/kg/day, which he discontinued after three days. However, he resumed treatment four days later after the reappearance of symptoms. On the third day after the resumption of treatment, corresponding to 10 days after the onset of symptoms, the patient presented with clinical aggravation marked by impaired consciousness. 

Clinical examination revealed a fever at 39°C, impaired consciousness with a Glasgow score of 11, mucous membrane pallor, conjunctival jaundice, tachypnea with 40 cycles/min, bronchial rales, and tachycardia at 120 beats/min. He had a stable hemodynamic state with a blood pressure of 120/80 mm Hg. However, his Urine was Coca-Cola colored, prompting the diagnosis of Black Water Fever(BWF). 

Test strip urine examination showed hemoglobinuria at two plus, bilirubinuria at three plus, proteinuria at two-plus, and absence of urobilinogen, red blood cells, and leucocytes. His malaria RDT was positive, while the thick peripheral blood smear was negative. Also, the direct Coombs test was negative.

Biological examinations showed leucocytosis, normochromic anemia, and a normal platelet count. His other results were as follows- Urea: 74.9 mmol/L, serum creatinine: 559.6 μmol/L, proteinuria: 0.56 g/24 h, ASAT: 334 IU/L, ALAT: 185 IU/L, CRP: 92 mg/L, blood ionogram: 128 mEq/L of sodium and five mEq/L of potassium, TP: 100%, INR: 0.99, TCA: 29.5, TQ: 12 sec, and a blood bilirubin level of 200 mg/L predominantly unconjugated. His abdominal ultrasound revealed normal-sized kidneys, discrete renal dedifferentiation, and vesicular sludge. Thus he received three hemodialysis sessions with a transfusion of erythrocyte concentrates. He was advised to continue his antimalarial treatment with an intramuscular artemether derivative. 

His clinical status and renal function normalized after seven days, and the patient received a discharge after being fully cured.

Mahamadou D, Hassane DM, Zeinabou MTM. et al. A Report of Four Cases of Blackwater Fever after Quinine Treatment at Zinder National Hospital, Niger Republic. Case Reports in Infectious Diseases. 2019; 2019. https://doi.org/10.1155/2019/2346087