Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis.

Abstract

INTRODUCTION:

A 22-year-old Malay soldier developed dapsone hypersensitivity syndrome 12 weeks after taking maloprim (dapsone 100 mg/pyrimethamine 12.5 mg) for anti-malarial prophylaxis.

CLINICAL PICTURE:

He presented with fever, rash, lymphadenopathy and multiple-organ involvement including serositis, hepatitis and thyroiditis. Subsequently, he developed congestive heart failure with a reduction in ejection fraction on echocardiogram, and serum cardiac enzyme elevation consistent with a hypersensitivity myocarditis.

TREATMENT:

Maloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor.

OUTCOME:

He has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission.

CONCLUSION:

In summary, we report a case of dapsone hypersensitivity syndrome with classical symptoms of fever, rash and multi-organ involvement including a rare manifestation of myocarditis. To our knowledge, this is the first case of dapsone-related hypersensitivity myocarditis not diagnosed in a post-mortem setting. As maloprim is widely used for malaria prophylaxis, clinicians need to be aware of this unusual but potentially serious association.

• Authors: Rachael Y L Teo, Yong-Kwang Tay, Chong-Hiok Tan, Victor Ng, Daniel C T Oh
• Journal: Annals of the Academy of Medicine, Singapore (Ann Acad Med Singap) Vol. 35 Issue 11 Pg. 833-6 (Nov 2006) ISSN: 0304-4602 [Print] Singapore
• PMID: 17160201 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Dapsone

Topics

• Abdominal Pain (drug therapy)
• Adult
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Biopsy
• Dapsone (adverse effects, therapeutic use)
• Diagnosis, Differential
• Drug Hypersensitivity (complications, pathology)
• Echocardiography
• Electrocardiography, Ambulatory
• Fever (drug therapy)
• Follow-Up Studies
• Humans
• Male
• Myocarditis (diagnosis, etiology)
• Radiography, Thoracic
• Skin (pathology)
• Thyrotoxicosis (diagnosis, etiology)