A fatal case of drug-induced multi-organ damage in a patient with Hansen's disease: dapsone syndrome or rifampicin toxicity?
An elderly patient with borderline tuberculoid Hansen's disease (leprosy) developed the diaminodiphenylsulphone syndrome after approximately 8 weeks of multi-drug therapy comprising dapsone and rifampicin. Postmortem histological examination, following autopsy, demonstrated features consistent with drug-induced hepatitis, tubulo-interstitial nephritis and myocarditis. Although these could have been engendered by dapsone toxicity, it was thought that a concommitant adverse reaction to rifampicin, which is known to be hepatotoxic, nephrotoxic and possibly capable of predisposing to the dapsone syndrome, could not be excluded.
Lau
G
G
Department of Forensic Medicine, Institute of Science and Forensic Medicine, Singapore.
D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003622:Dapsone / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006801:Humans; D007668:Kidney / Q000473:pathology; D007918:Leprosy / Q000188:drug therapy*; D008099:Liver / Q000473:pathology; D008297:Male; D009205:Myocarditis / Q000139:chemically induced; D009206:Myocardium / Q000473:pathology; D009395:Nephritis, Interstitial / Q000139:chemically induced; D012293:Rifampin / Q000009:adverse effects*
D003622:Dapsone; D012293:Rifampin