A Case Report on Dapsone Induced Dress Syndrome

Abstract

Introduction: Drug reaction with eosinophilia and systemic syndrome is a severe idiosyncratic drug induced reaction. DRESS syndrome should be considered in any patient with skin eruption, fever, eosinophilia or liver and hematological abnormalities. Case Description: This is a case report of dapsone induced DRESS syndrome of which a 24 years female patient was admitted in hospital with chief complains of low grade fever since one month, yellowish discoloration of eyes since 15 days, giddiness since two weeks, malaise and myalgia since 4 days, painful lesion on tongue since one week, burning sensation of palms and stomach with blurring of vision. Her past history revealed that known case of lepromatous leprosy since one month and for that using dapsone 100 mg, so based on patient signs and symptoms and past history, physicians advised CBC, LFT, RFT and biochemistry, serum electrolytes and retic count, HBSAG, HCV, vitamin b12, serum folic acid, abdomen pelvic sonography and AFB staining. In which CBC, RFT, LFT were abnormal. AFB staining shows AFB morphologically resembling that of mycobacterium leprae seen and confirmed final diagnosis. The treatment initiated with suspected drug dapsone was withdrawn and further supportive treatment was given such as cefotaxime, pantoprazole, Urso deoxy cholic acid, IV fluid, iron folic acid tablets and vitamin b complex tablets and blood transfusion of packed red blood cells was performed to normalize the decreased hemoglobin and red blood cells. For management of leprosy minocycline was included as a alternative drug. After treatment, the outcome of patient condition were improving and her symptoms got reduced. Conclusion: The management of this syndrome with prompt discontinuation of the culprit drug and supportive therapy was initiated. Therefore clinicians who are prescribing dapsone for different clinical conditions should have awareness about DRESS syndrome and it’s presentation of potentially becoming fatal.