Abstract
Multidrug therapy for Leprosy is currently done with Dapsone, Clofazimine and Rifampicin. Dapsone is known to cause hemolytic anemia and this adverse event during MDT seems to be more frequent than reported. Lepra reactions can occur at presentation, during treatment or even after completion of MDT. Inadequate and interruption of treatment is an obstacle to eradication. 65 year old female clinically diagnosed leprosy, as patient developed multiple hypopigmented plaques on skin and swelling and decreased sensation over right hand initiated on MDT presented with complains of hematuria on Day 4 of therapy. Blood investigation revealed hemolytic anemia. Dapsone was stopped and blood products given. Dapsone inhibits bacterial synthesis of Dihydrofolic acid. The main side-effects usually described are allergic, such as itchy rash and exfoliative dermatitis, hemolytic anemia (HA), jaundice, methemoglobinemia and dapsone syndrome. Type 1 reaction or “reversal reaction" presents with worsening of pre-existing skin lesions, thickening of nerve ber with neuropathy and edema. Type 2 reaction or erythema nodosum leprosum (ENL) have painful erythematous skin nodules. This case highlights fundamental understanding of the treatment options, prompt diagnosis and treatment of reactions which are essential to reduce disease burden and improve patient's quality of life.
Published Version
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