Dapsone syndrome with acute renal failure during leprosy treatment: case report

Abstract

Dapsone syndrome is a rare hypersensitivity reaction to dapsone and is characterized by high fever, papular or exfoliative dermatitis, progressing to liver toxicity and generalized lymphadenopathy, resembling a mononucleosis infection. We report a patient who developed acute renal failure, as well as other complications characteristic of dapsone syndrome, during leprosy treatment. Renal involvement had not been previously described as a dapsone syndrome feature.

Medically Significant Hypersensitivity Reaction to Dapsone: A Case Report

“…6 Dapsone hypersensitivity syndrome is neither dose dependent nor time dependent. Dapsone use can induce hemolytic anemia, 3 renal injury, 7 toxic effects on thyroid 8 . Patients experiencing DHS should discontinue the suspect drug immediately and should be managed with topical and systemic steroids, antibiotics, supportive care, nutritional support and fluid replacement.…”

Guidelines for the diagnosis and treatment of dermatitis herpetiformis

“…Table 4 presents the main adverse reactions to dapsone, classified as toxic and idiosyncratic. Such adverse effects are usually dose dependent and more common in patients with comorbidity (anaemia, cardiopulmonary disease, glucose‐6‐phosphate‐dehydrogenase deficiency) 38–45 . Dapsone can induce a severe hypersensitivity syndrome, consisting of fever, rash, malaise, lymphadenopathy, and varying degrees of visceral involvement, which develops in about 5% of dermatitis herpetiformis patients 2–6 weeks after the beginning of treatment 38–45 …”

“…Dapsone represents a valid therapeutic option for dermatitis herpetiformis patients during the 1-to 2-year period until the GFD is effective; [38][39][40][41][42][43][44][45] dosages of 1/mg/kg/day can control itching and blister development. [38][39][40][41][42][43][44][45] Although dapsone does effectively decrease pruritus and inflammatory lesions, patients taking this drug should be strictly monitored (especially for renal and liver function) because of possible severe adverse effects. [38][39][40][41][42][43][44][45] In particular, the commonest side-effect of dapsone is haemolysis and patients should be seen within 2 weeks after starting the drug as haemolysis may be acute in some individuals.…”

“…[38][39][40][41][42][43][44][45] Although dapsone does effectively decrease pruritus and inflammatory lesions, patients taking this drug should be strictly monitored (especially for renal and liver function) because of possible severe adverse effects. [38][39][40][41][42][43][44][45] In particular, the commonest side-effect of dapsone is haemolysis and patients should be seen within 2 weeks after starting the drug as haemolysis may be acute in some individuals. Table 4 presents the main adverse reactions to dapsone, classified as toxic and idiosyncratic.…”

“…[38][39][40][41][42][43][44][45] Dapsone can induce a severe hypersensitivity syndrome, consisting of fever, rash, malaise, lymphadenopathy, and varying degrees of visceral involvement, which develops in about 5% of dermatitis herpetiformis patients 2-6 weeks after the beginning of treatment. [38][39][40][41][42][43][44][45] Sulfasalazine and sulphamethoxypyridazine might provide an effective alternative to dapsone especially when it fail to control the disease or the therapy is complicated by adverse events. 5,46,47 The suggested dosages are of 1-2 g/day for sulfasalazine and of 0.25-1.5 g/day for sulphamethoxypyridazine.…”