Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis.
- Author:
Rachael Y L TEO
1
;
Yong-Kwang TAY
;
Chong-Hiok TAN
;
Victor NG
;
Daniel C T OH
Author Information
- Publication Type:Case Reports
- MeSH: 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
- From:Annals of the Academy of Medicine, Singapore 2006;35(11):833-836
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONA 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 PICTUREHe 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.
TREATMENTMaloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor.
OUTCOMEHe has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission.
CONCLUSIONIn 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.
