Clofazimine/dapsone/rifampicin

Abstract

A 37-year-old man developed acute pancreatitis during treatment with clofazimine, dapsone and rifampicin for multibacilary leprosy.The man was diagnosed with multibacilary leprosy. He received treatment with rifampicin 600mg monthly, dapsone 100mg daily, along with clofazimine 50mg daily and 300mg monthly [routes not stated] as per the PCT/MB regimen. After 3 weeks of PCT/MB therapy, he presented with several days of worsening of a left upper quadrant abdominal pain that radiated to the back. On presentation, laboratory tests showed elevated serum amylase and lipase, neutrophils 8,550 /mm 3 , lactate dehydrogenase 264 U/L, C-reactive protein 46 mg/L and erythrocyte sedimentation rate 25 mm/h. Hence, he was admitted. On day 28 after the start of PCT/ MB therapy, total abdomen CT showed signs of acute pancreatitis and diffuse tail/body thickening with oedema. On day 34, upper abdomen MRI showed signs of acute pancreatitis, with tail oedema. Gallbladder with finely heterogenous content was noted, suggestive of biliary sludge. In addition, discrete amount of free liquid in the upper abdomen was noted. Small bilateral pleural effusion also observed. Based on these examinations and his medical history, a diagnosis of acute pancreatitis secondary to clofazimine, dapsone and rifampicin was made.Therefore, the man's treatment with clofazimine, dapsone and rifampicin was suspended. In addition, he was treated with IV hydration, unspecified analgesia, unspecified bowel resting drugs, metronidazole and clindamycin. Subsequently, his condition improved and was discharged after 8 days of hospitalisation (on day 35 after the start of PCT/MB therapy). Subsequent imaging studies revealed improvement in his condition.One month later (on day 63), the man's clofazimine, dapsone and rifampicin therapy was re-started. In less than 24 hours following the medications intake, a rapidly worsening abdominal pain reappeared. On day 65, he was again admitted. At this time, laboratory and imaging tests showed similar findings, including elevated serum amylase and lipase, and pancreatic oedema. On day 81, thoracic CT showed small pericardial effusion and small left pleural effusion. The clinical course and management were also similar, and after almost 3 weeks (on day 82), he was discharged from hospital. On day 97, upper abdomen MRI and cholangioresonance studies showed improvement in his condition. He lost 11kg of weight in 3 months since the first hospitalisation. Three months after the second hospital discharge, dapsone was replaced by ofloxacin; however, clofazimine and rifampicin were maintained with the same posology. Within a month, he had no recurrence of the pancreatitis.