Dapsone induced cholangitis as a part of dapsone syndrome: a case report.
BACKGROUND
Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. Dapsone syndrome is a manifestation of the DRESS (drug rash with eosinophilia and systemic symptoms) syndrome which is a serious condition that has been reported in association with various drugs. Cholangitis in dapsone syndrome has not been reported so far in the world literature.


METHODS
We report a patient who presented with fever, exfoliative dermatitis, jaundice and anemia within three weeks of starting of dapsone therapy. These features are typical of dapsone syndrome, which is due to dapsone hypersensitivity and is potentially fatal. Unlike previous reports of hepatitic or cholestatic injury in dapsone syndrome we report here a case that had cholangitic liver injury. It responded to corticosteroids.


CONCLUSIONS
We conclude that cholangitis, though unusual, can also form a part of dapsone syndrome. Physicians should be aware of this unusual picture of potentially fatal dapsone syndrome.
Itha
Srivenu
S
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow-226014, India. srivenu@sgpgi.ac.in
Kumar
Ashish
A
Dhingra
Sadhna
S
Choudhuri
Gourdas
G
D000328:Adult; D002761:Cholangitis / Q000139:chemically induced*; D003622:Dapsone / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology; D004342:Drug Hypersensitivity / Q000209:etiology*; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D007917:Leprostatic Agents / Q000009:adverse effects*; D008297:Male; D013577:Syndrome
D007917:Leprostatic Agents; D003622:Dapsone