Quinine-mediated disseminated intravascular coagulation

Quinine is widely used for the treatment of nocturnal leg cramps and is also commonly present in small quantities in ‘bitter’ soft drinks. Recognised haematological problems associated with the ingestion of quinine include thrombocytopenia, haemolytic anaemia, neutropenia and disseminated intravascular coagulation (DIC). Five cases of quinine-associated DIC have been reported to date.1–3 We would like to report a further case which occurred after only two doses of quinine sulphate separated by an interval of 3 months. A 79-year-old woman, who was previously fit and healthy, was admitted via Accident and Emergency with a recent onset of multiple bruises, melaena, and hypotension. She was taking bendrofluazide 2.5 mg daily for hypertension. Three months earlier she had complained of leg cramps and had been prescribed quinine sulphate 300 mg as necessary. One dose had been used with good effect at that time. Two days before admission she had suffered dysuria and frequency of micturition but had received no antibiotic therapy. Leg cramps again became a problem and she took a second dose of quinine sulphate 300 mg. Within 12 hours she had developed spontaneous bruising, haematuria, haemoptysis, melaena, and lightheadedness.