3.Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis.
Rachael Y L TEO ; Yong-Kwang TAY ; Chong-Hiok TAN ; Victor NG ; Daniel C T OH
Annals of the Academy of Medicine, Singapore 2006;35(11):833-836
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
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