Lack of Suspicion of Dapsone Hypersensitivity Syndrome in a Leprosy Patient: Case Report with Fatal Outcome

• Main Authors: Ansah R, Arkoh EA, Quao BO, Groger M
• Format: Article in Journal/Newspaper
• Language: English
• Published: Dove Medical Press 2023
• Subjects: multidrug therapy; exfoliative dermatitis; adverse drug reaction; hepatomegaly; sulfone antibiotic; steroid; Arctic medicine. Tropical medicine; RC955-962; Arctic; Benedict
• Online Access: https://doaj.org/article/7998017847eb436d811a68dcae16c72a

Ruth Ansah,1 Ebenezer Ameyaw Arkoh,2 Benedict Okoe Quao,2,3 Mirjam Groger1 1Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Ankaful Leprosy / General Hospital, Ankaful, Central Region, Ghana; 3National Leprosy Control Program, Ghana Health Service, Accra, GhanaCorrespondence: Mirjam Groger, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, Hamburg, D-20359, Germany, Tel [phone], Email [e-mail]: Dapsone is an antibiotic used in the management of leprosy. Following the worldwide adoption of the dapsone-containing multidrug therapy for treating leprosy, an upsurge in the reported frequency of dapsone hypersensitivity syndrome (DHS) has been observed. DHS is associated with a high fatality rate among patients from low-resourced settings and patients with syndrome-associated hepatitis.Case Presentation: This is a case of a Ghanaian male who, while being treated for leprosy with the multidrug therapy, developed exfoliative dermatitis and signs of liver damage, 6 weeks after treatment initiation. He was managed for dapsone-related exfoliative dermatitis and infectious causes of liver damage were investigated. However, the patient’s condition rapidly deteriorated with a fatal outcome despite discontinuation of dapsone. DHS was only considered as a differential diagnosis postmortem.Conclusion: This case highlights the importance of having a high index of suspicion for DHS in all patients on dapsone and the need for a thorough workup for all leprosy patients who present with exfoliative dermatitis and signs of liver involvement within the latency period of the syndrome, especially in low resource settings. Furthermore, it stresses the need for prompt and appropriate treatment as DHS can quickly become fatal in such settings.Keywords: multidrug therapy, exfoliative dermatitis, adverse drug reaction, hepatomegaly, sulfone antibiotic, steroid