Abstract

Introduction: Synthetic anti malaria drugs has effectiveness in the treatment of many auto-immune diseases and principally the systemic erythematous lupus. The undesirable effects remain rare. The appearance of myopathy is considered as exceptional. We report observations which highlight the hypothesis of a double toxicity (Chloroquine and Hydroquinine). Observation: We report a case of 53 years old female patient treated chronically by Hydroquinidine and Escitalopram for Bouveret diseases which became asymptomatic. Later on, we had Chloroquine and Prednisone to the previous treatment. Prednisone was removed few months later because of a possible skin side effect. Due to the incomplete relief of joint pain we had Methotrexate to the treatment associated to Omeprazole. And the evolution was characterized by the appearance of lower limbs muscle weakness leading to the interruption of Methotrexate- Omeprazole association. Despite this interruption there was a worsening of the muscle weakness clinically and electro-physiologically diagnosed as myopathy which leads to the interruption of Chloroquine and Hydroquinidine. Other causes of myopathy have been ruled out after a large check-up and Methotrexate was re-introduced two months later with progressive regression of symptoms within six months. Discussion and conclusion: The appearance of myopathy in a patient treated by Chloroquine is extremely rare. Our observation highlights the toxicity of synthetic antimalarial drugs which can cause myopathy in some cases. The association of Chloroquine and Hydroquinidine seems potentially more toxic on muscles.

Keywords: Myopathy; Chloroquine; Hydroquinidine