Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis.
BACKGROUND
A 22-year-old Malay soldier developed dapsone hypersensitivity syndrome 12 weeks after taking maloprim (dapsone 100 mg/pyrimethamine 12.5 mg) for anti-malarial prophylaxis.


METHODS
He presented with fever, rash, lymphadenopathy and multiple-organ involvement including serositis, hepatitis and thyroiditis. Subsequently, he developed congestive heart failure with a reduction in ejection fraction on echocardiogram, and serum cardiac enzyme elevation consistent with a hypersensitivity myocarditis.


METHODS
Maloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor.


RESULTS
He has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission.


CONCLUSIONS
In summary, we report a case of dapsone hypersensitivity syndrome with classical symptoms of fever, rash and multi-organ involvement including a rare manifestation of myocarditis. To our knowledge, this is the first case of dapsone-related hypersensitivity myocarditis not diagnosed in a post-mortem setting. As maloprim is widely used for malaria prophylaxis, clinicians need to be aware of this unusual but potentially serious association.
Teo
Rachael Y L
RY
Division of Dermatology, Changi General Hospital, Singapore.
Tay
Yong-Kwang
YK
Tan
Chong-Hiok
CH
Ng
Victor
V
Oh
Daniel C T
DC
D015746:Abdominal Pain / Q000188:drug therapy; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D003622:Dapsone / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000150:complications* / Q000473:pathology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005334:Fever / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000209:etiology*; D013902:Radiography, Thoracic; D012867:Skin / Q000473:pathology; D013971:Thyrotoxicosis / Q000175:diagnosis / Q000209:etiology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003622:Dapsone