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