Introduction: Black water fever (BWF) is a complication of severe Plasmodium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes severe anemia and passage of dark/cola color urine, leading to acute renal failure. Hemoglobinuria or BWF is a rare and severe manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and presence of abnormal hemoglobin in the urine. Aim: The aim of this study was to diagnose and treat severe malaria infection in a Nigerian patient admitted to the Casualty of the IDH Hospital. Case Presentation: A 20-year-old Nigerian boy came to Kuwait and started complaining abdominal pain, nausea, vomiting and fever two days after his arrival. The investigation revealed high fever (40.8˚C), heart rate 125, blood pressure of 100/60 mmHg. The physical examination was unremarkable, including a normal neurologic examination, no hepatosplenomegaly, rash and neck rigidity. The Giemsa stained thick and thin blood examination confirmed the severe infection of Plasmodium falciparum with 41.0% parasitemia. The patient was admitted to the hospital and started intravenous Quinine (1200 mg loading dose in 5% glucose over 4 hours). The patient was feeling much better on next morning but became unconscious by evening and shifted to ICU. His all CBC parameters were higher and started passing dark/cola color urine. The 12 units of whole blood were exchanged on next morning and became fully conscious on 4th day and his anemia and thrombocytopenia were improved and the color of the urine also became normal. Conclusion: Quinine is used in both complicated and uncomplicated malaria and may cause black water fever in severe infection of P. falciparum . It is caused by the hemolysis of erythrocytes due to malaria and also with the metabolism of quinine, making these cells more vulnerable to hemolysis in falciparum malaria and also in G6PD deficiency.
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