CASE REPORT- A RARE CASE OF DAPSONE HYPERSENSITIVITY SYNDROME

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.