Dapsone hypersensitivity syndrome in an adolescent during treatment during of leprosy

Abstract

A 12 y old girl was admitted 24 days after start a WHO multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. The main laboratory data on admission included: hemoglobin, 8.4 g/dL; WBC, 15,710 cells/mm3; platelet count, 100,000 cells/mm3; INR = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. Following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. Ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. This presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). Physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.

Adverse reactions in leprosy patients who underwent dapsone multidrug therapy: a retrospective study

“…In a report, it has been mentioned that hemolytic anemia was one of the common side effects seen in leprosy patients treated with dapsone,3 which was similar to our result. However, contrary to others, we did not find renal failure and nephritis as a common dapsone side effect in MDT-treated patients 14,15…”

Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy

“…Tuberculoid leprosy usually takes months, and not years, to respond to the correct treatment, and this should have been taken into account. During the late course of the disease, the appearance of constitutional symptoms plus signals of systemic compromise as lymph node hypertrophy and hepatosplenomegaly were interpreted as a severe drug reaction (a drug-hypersensitivity syndrome) caused by rifampicin or dapsone 2 , or as an atypical type 1 leprosy reaction. The first hypothesis, drug reaction with eosinophilia and systemic symptoms, a drughypersensitivity syndrome nowadays known by the acronym, DRESS usually develops two to six weeks after starting the medication, most commonly phenytoin, carbamazepine, phenobarbital or sulfonamides and presents fever, facial edema and cutaneous rash 11,13 .…”

Leprosy: Not always an easy diagnosis and often a management challenge

“…4 weeks after institution of treatment the first case was admitted to hospital with dapsone hypersensitivity syndrome. Although a rare complication with the use of dapsone, this severe adverse effect has been reported during treatment for leprosy 13 …”