Megaloblastic Anemia in a Patient on Peritoneal Dialysis Returning from Kenya

This case study described a 40-year-old man on peritoneal dialysis who developed megaloblastic anemia and diffuse nonscarring hair loss after returning from Kenya, where he took atovaquone-proguanil (A-P) for malaria prophylaxis. The anemia and hair loss were linked to proguanil, a folate analogue that inhibits dihydrofolate reductase, disrupting DNA synthesis. This drug is contraindicated in chronic kidney disease (CKD) due to proguanil accumulation. Treatment involved discontinuing A-P, administering folinic acid to stimulate thymidylate synthesis, and providing supportive care, including transfusions. The study highlighted that proguanil is poorly dialyzable, emphasizing the need for caution in CKD patients.