Dapsone syndrome

In France, dapsone is available in combination with ferrous oxalate as Disulone (Aventis), and in 1983-98, 249 adverse reactions were reported to French pharma-covigilance centers, mainly blood dyscrasias (often neutropenia and agranulocytosis, rarely hemolysis and anemia) (11). Five patients died three of them had septicemia secondary to agranulocytosis. There were 29 cases of dapsone syndrome, 39 skin reactions, 27 cases of hver damage, and 27 cases of neurological and psychiatric adverse effects. Patients taking dapsone need to be under close medical supervision for early recognition of adverse reactions. 

Pmritus and varions forms of rash can occnr with dapsone. In 17 cases of dapsone syndrome, the sjmptoms developed on average 27 days after the start of treatment. The skin lesions took the form of erythematons papnles and plaques (n = 13), eczematous lesions (n — 4), and associated bnllons lesions (n — 2) (28). The other manifestations were fever (n — 16), prnritus (n = 15), lymphade-nopathy (n = 14), hepatomegaly (n = 10), ictems and oral erosions (n = 5 each), photosensitivity (n = 4), and splenomegaly (n = 2). 

Kumar RH, Kumar MV, lliappa DM. Dapsone syndrome—a five year retrospective analysis. Indian J Lepr 1998 70(3) 271-6. 

Pavithran K. Dapsone syndrome with polyarthritis a case report. Indian J Lepr 1990 62(2) 230-2. 

A dapsone syndrome was reported in a 30-year-old woman after 4 weeks of treatment with Maloprim and chloroquine base 300 mg/weekly. The symptoms comprised fever, joint and muscle pains, dry cough, and a diffuse red urticarial rash, followed by generalized lym-phadenopathy, a painful exudative tonsillitis, and a prominent atypical lymphocytosis. 

Alves-Rodrigues EN, Ribeiro LC, Silva MD,Takiuchi A, Fontes CJ. Dapsone syndrome with acute renal failure during leprosy treatment case report. Braz J Infect Dis. 2005 Feb 9(l) 84-6. 

Lau G. A fatal case of drug-induced multi-organ damage in a patient with Hansen s disease dapsone syndrome or rifampicin toxicity Forensic science international. 1995 May 22 73(2) 109-15. 

Note A hypersensitivity reaction - termed the sulfone syndrome or dapsone syndrome - may infrequently develop during the first six weeks of treatment. This syndrome consists of exfoliative dermatitis, fever, malaise, nausea, anorexia, hepatitis, jaundice, lymphadenopathy and hemolytic anemia. See (1982) Kromann NP +, Arch Dermatol I 18, 531... 

Immunologic In the dapsone syndrome (or sulfone syndrome) there is fever, exfohative dermatitis and photosensitivity, jaundice, hepatosplenomegaly, generalized lymph-adenopathy, and pruritus. In one case there was a bullous skin eruption with circulating 190 and 230 kDa autoantibodies [62 ]. 

The pathophysiology of the dapsone syndrome is unclear, but dapsone metabolites may act as haptens, resulting in the formation of antidapsone antibodies. Dapsone is metabolized primarily via A/-acetylation and /V-hydroxylation. The A -hydroxylation pathway is thought to be the initial step in the formation of toxic intermediate... 

Janndice and hepatitis can occnr as part of the sulfone syndrome with dapsone (26). Previons liver damage can predispose to serions hepatic or other adverse effects. 

Kraus A, Jakez J, Palacios A. Dapsone induced sulfone syndrome and systemic lupus exacerbation. J Rheumatol... 

Tomecki KJ, Catalano CJ. Dapsone hypersensitivity. The sulfone syndrome revisited. Arch Dermatol 1981 117(l) 38-9. 

Mohle-Boetani J, Akula SK, Holodniy M, Katzenstein D, Garcia G. The sulfone syndrome in a patient receiving dapsone prophylaxis for Pneumocystis carinii pneumonia. West J Med 1992 156(3) 303-6. 

Three patients developed a hypersensitivity syndrome after taking pyrimethamine 12.5 mg + dapsone 100 mg weekly as malaria prophylaxis (16). The diagnosis was based on the presence of fever, lymphadenopathy, a maculopapular rash, and hepatitis. A mild Coombs -positive hemolytic anemia was also observed in one of the patients. All the clinical, hematological, and biochemical abnormalities normalized within 3 months of tapering regimens of moderate-dose prednisolone. 

Thong BY, Leong KP, Chug HH. Hypersensitivity syndrome associated with dapsone/pyrimethamine (Maloprim) antimalaria chemoprophylaxis. Ann Allergy Asthma Immunol 2002 88(5) 527-9. 

Linear IgA dermatosis with erythema multiforme-Uke clinical features has been reported in a 19-year-old man several days after completion of a 5-day-course treatment with sulfadimethoxine (500 mg bd) for a flu-like syndrome (134). Treatment with methylprednisolone (150 mg) with gradnal dosage rednction was started. Slow improvement was followed by a flare-up after reduction to 80mg/day. Therapy was changed to dapsone 100 mg/day, and there was a dramatic improvement. 

A number of drugs of miscellaneous class are capable of producing various degrees of renal damage and will be reviewed in this Chapter. Some have been used extensively in the past for the treatment of general infections (sulfonamides), others have had specific indications (pentamidine, dapsone), and others such as quinolones are of more recent application. Many of these, however, are of current interest because of their use in treating the complications occurring in patients with acquired immunodeficiency syndrome (AIDS). 

It appears that dapsone is a safe drug when used in standard dosage. Perhaps, renal involvement should be watched for when administering dapsone to patients with G6PD deficiency that could develop hemolytic complications [207] and in patients that present with dapsone hypersensitivity syndrome. 

Medina I, Mills J, Leoung G, Hopewell PC, Eee B, Modin G, et al. Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone. The New England journal of medicine. 1990 Sep 20 323(12) 776-82. 

Sener O, Doganci L, Safali M, Besirbellioglu B, Bulucu F, Pahsa A. Severe dapsone hypersensitivity syndrome. J Investig Allergol Clin Immunol. 2006 6(4) 268-70. 

Bucaretchi F, Vicente DC, Pereira RM, Tresoldi AT. Dapsone hypersensitivity syndrome in an adolescent during treatment during of leprosy. Revista do Institute de Medicina Tropical de Sao Paulo. 2004 Nov-Dec 46(6) 331-4. 

Lee BL, Medina 1, Benowitz NL, Jacob P, 3rd, Wofsy CB, Mills Jt. Dapsone, trimethoprim, and sulfamethoxazole plasma levels during treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Evidence of drug interactions. Annals of internal medicine. 1989 Apr 15 110(8) 606-n. 

Belmont A. Dapsone induced nephrotic syndrome. Jama. 1967 200 262-3. 

Since the first edition of this book was published there have been substantial advances in the treatment of human immunodeficiency virus (HIV) infection and the corollary acquired immunodeficiency syndrome (AIDS). Multiregimen antiretroviral therapy has allowed HIV/AIDS to be managed in a manner that was impossible in 1992. The development of successful treatments for HIV/AIDS and the effectiveness of antimicrobials, trimethoprim/sulfamethoxazole or dapsone, in the treatment of Pneumocystic carinii pneumonia (PCP) have reduced... 

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