A young woman who had a delivery history 3 months previously presented with dyspnea and orthopnea. Initial findings of physical examination, chest radiography, and echocardiogram showed typical congestive heart failure with severe left ventricular (LV) dysfunction. At first, we considered peripartum cardiomyopathy because she had given birth to a baby 3 months previously. However, even though we massively tried conventional drug therapy for 10 days, the patient still remained with refractory heart failure. We performed additional laboratory studies such as complement level and autoantibodies, of which the results supported systemic lupus erythematosus. We could make the diagnosis of acute lupus myocarditis and treated her with corticosteroid. The symptoms were dramatically disappeared and LV function also improved.
Acute Disease ; Administration, Oral ; Adult ; Echocardiography ; Female ; Glucocorticoids/administration & dosage ; Heart Failure/*diagnosis ; Humans ; Lupus Erythematosus, Systemic/complications/*diagnosis/radiography ; Methylprednisolone/administration & dosage ; Myocarditis/*diagnosis/etiology/radiography ; Prednisolone/administration & dosage

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.

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