title: Dapsone hypersensitivity syndrome-related lung injury without eosinophilia in the bronchoalveolar lavage fluid.
abstract: A 73-year-old man was admitted in respiratory failure that had subacutely progressed after five weeks of dapsone treatment for a skin rash. He also presented with fever, systemic erythroderma and liver dysfunction. Chest computed tomography showed diffuse reticular shadows with ground-glass opacity and bilateral mediastinal lymphadenopathy. Lymphocytes, but not eosinophils, were increased in the bronchoalveolar lavage fluid. Moreover, reactivation of human herpes virus-6 was confirmed on a paired serum test. Finally, we diagnosed the patient with dapsone hypersensitivity syndrome (DHS), a rare adverse event of this drug. Lung injury unaccompanied by eosinophilia in the bronchoalveolar lavage fluid is even more rare as a DHS-related lung manifestation.
authors.affiliation: Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kinehara
authors.forename: Takashi
authors.initials: T
authors.lastname: Kijima
authors.forename: Koji
authors.initials: K
authors.lastname: Inoue
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Hirata
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Kiyoharu
authors.initials: K
authors.lastname: Fukushima
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Hayama
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Higashiguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Morimura
authors.forename: Kotaro
authors.initials: K
authors.lastname: Miyake
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Minami
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagatomo
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Takeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kumanogoh
mesh_terms: D055371:Acute Lung Injury / Q000139:chemically induced; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003622:Dapsone / Q000009:adverse effects*; D003937:Diagnosis, Differential; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis / Q000209:etiology*; D004802:Eosinophilia / Q000175:diagnosis; D004804:Eosinophils / Q000502:physiology; D005334:Fever / Q000139:chemically induced; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced; D007958:Leukocyte Count; D008206:Lymphatic Diseases / Q000139:chemically induced; D008214:Lymphocytes / Q000502:physiology; D008218:Lymphocytosis / Q000139:chemically induced; D008297:Male; D008477:Mediastinal Diseases / Q000139:chemically induced; D011537:Pruritus / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D019349:Roseolovirus Infections / Q000139:chemically induced; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D003622:Dapsone