KEY CLINICAL MESSAGE
Dapsone hypersensitivity syndrome (DHS) is a severe idiosyncratic drug
reaction in response to dapsone characterised by the clinical symptoms
of fever, skin eruption, and internal organ involvement including liver.
Here we report a case who presented with fatigue, jaundice and mild
upper abdominal pain 3 weeks after starting anti-leprosy drug regimen
comprising dapsone. Examination showed icteric sclera and pallor over
nails and palms, mild tenderness over right hypochondrium and there were
regressing leprosy skin lesions over dorsum of right hand and left foot.
We immediately discontinued antileprotics for 2 weeks and patient was
put on oral steroids. Liver function tests were near normal during
follow up and patient was advised to continue antileprotics as usual
with counselling when to return. Clinically, early recognition of
dapsone induced hepatitis (DIH) is important based on mucocutaneous
findings to minimize injury. Laboratory monitoring should be frequently
performed during treatment, including complete blood counts and liver
function tests. Early detection, prompt withdrawal of dapsone, and
minimal use of other sulfa drugs need to be emphasized for the
management of DHS.
Keywords: Dapsone hypersensitivity syndrome, Dapsone induced
hepatitis, leprosy, Sulfa drugs