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

Abstract

Background

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

Abbreviations

ALP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; DHS, dapsone hypersensitivity syndrome; EGFR, Estimated Glomerular Filtration Rate; FBC, Full Blood Count; GGT, gamma-glutamyl transaminase; HIV, human immunodeficiency virus; MDT, multidrug therapy.

Consent for Publication

Written informed consent for publication of the patient’s clinical details and/or clinical images was obtained from the relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Institutional approval for publication of case details was given by the management of the Ankaful Leprosy/ General Hospital.

Acknowledgments

We would like to express our sincere appreciation to the healthcare professionals involved in the patient’s care, whose expertise and dedication were invaluable.

We extend our gratitude to the patient’s next of kin for his consent to use the patient’s data.

We acknowledge the assistance of the Medical Records Department at Ankaful General and Leprosy Hospital for providing access to essential patient data.

Disclosure

The authors report no conflicts of interest in this work.