CASE REPORT- A RARE CASE OF DAPSONE HYPERSENSITIVITY SYNDROME

Abstract

INTRODUCTIONDapsone is a leprostatic
drug used in treatment of multibacillary
and paucibacillary leprosy. A rare, fatal
systemic hypersensitivity syndrome called
Dapsone Hypersensitivity Syndrome characterized
by fever, skin rash, eosinophilia,
lymphadenopathy, hepatic, pulmonary and
other systemic manifestations can complicate
dapsone therapy. CASE REPORTA
26 year old male was admitted with complaints
of fever, vomiting, rashes over both
upper and lower limbs, swelling over both
sides of neck . Patient developed above
complaints after 5 weeks of initiation of
multidrug therapy for leprosy. On examination
pallor, jaundice, bilateral cervical lymphadenopathy,
erythema and scaling of
skin over both the extremities were present.
Lab investigations showed eosinophilia
and mild elevation of liver enzymes.
A diagnosis of Dapsone hypersensitivity
syndrome was made based on history of
dapsone intake, followed by fever, skin
rash, eosinophilia, lymphadenopathy and
hepatitis.
Tablet Dapsone was stopped immediately.
He was started on IV Antibiotics, IV
Dexamethasone, Tablet Paracetamol. After
7 days IV Dexamethasone was
changed to T. Prednisolone 60 mg day
and tapered and stopped over the next 4
weeks. The patient responded well to
therapy.DISCUSSIONDapsone is metabolized
by two pathways, N-acetylation
and N-hydroxylation. The formation of
toxic intermediate metabolites such as hydroxylamines
and possibly other compounds
through N-hydroxylation pathway
were responsible for dapsone syndrome.
A high index of suspicion for early diagnosis,
along with prompt treatment are essential
to prevent fatalities.