A 50-Year-Old Male with Dapsone Hypersensitivity Syndrome

Azmiree Binte Aslam,Farhana Wahab,Lubna Khondker

doi:10.3329/jemc.v8i2.36736

Abstract

Dapsone, diamino-diphenyl sulfone, is an antibacterial and anti-inflammatory drug which is used worldwide for treating many diseases, such as leprosy, dermatitis herpetiformis, linear IgA bullous dermatosis, chronic bullous dermatosis of childhood, bullous eruption of systemic lupus erythematosus, erythema elevatum diutinum, leukocytoclastic vasculitis, polyarteritis nodosa and other kinds of vasculitis, prurigo nodularis, nodulocystic acne, cutaneous mycetoma, pustular psoriasis, malaria, pneumocystis carinii pneumonia etc. Since it is widely used, the adverse effects of this drug attract the attention of doctors from different specialities. Dapsone can cause several adverse effects, the most serious one is idiosyncratic systemic hypersensitivity syndrome, namely dapsone hypersensitivity syndrome (DHS), which is potentially fatal, characterized by fever, facial edema with infiltrated papules, generalized papulopustular or exanthematous rash which may extend to exfoliative dermatitis, eosinophilia, lymphadenopathy, hematologic involvement and organ involvement such as hepatitis, nephritis, pneumonitis, encephalitis, myocarditis occurring after 3–6 weeks of drug therapy. Here we have described a case of dapsone hypersensitivity syndrome developed after dapsone therapy for prurigo nodularis. The case is being reported to emphasize the need for timely diagnosis and prompt treatment of this rare complication for successful outcomes. Physicians should be aware of this infrequent but potentially fatal severe form of adverse reaction that can mimic other conditions.J Enam Med Col 2018; 8(2): 108-113

Highlights

IntroductionDapsone hypersensitivity syndrome (DHS) can be considered as a manifestation of DRESS (drug rash with eosinophilia and systemic symptoms) syndrome.[1]
Dapsone hypersensitivity syndrome (DHS) can be considered as a manifestation of DRESS syndrome.[1]
DRESS is an adverse reaction that can be seen with the use of many drugs such as dapsone, sulfonamides, allopurinol, cyclosporine, azathioprine, minocycline, antiviral drugs, anticonvulsant and gold salt.[2]

Summary

Introduction

Dapsone hypersensitivity syndrome (DHS) can be considered as a manifestation of DRESS (drug rash with eosinophilia and systemic symptoms) syndrome.[1]. It has a frequency of 0.2–0.5% in patients on dapsone therapy.[1] DHS was described first by Allday, Lowe and Barnes as a hypersensitivity vasculitis syndrome. This syndrome typically presents with a triad of fever, skin eruption, and internal organ (lung, liver, neurological and other systems) involvement. After getting medication for one month he developed fever which was high grade, intermittent and was associated with chills and rigor After seven days his body was studded with morbiliform eruption that progressed to generalized exfoliation in the few days. Prednisolone was tapered to 30 mg after four weeks of therapy and continued to taper slowly in the following weeks

Discussion

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Conclusion