Dapsone Induced Liver Injury, Hansen’s Disease, Multibacillaery-MDT: A Case Report

Abstract

Dapsone is an important component of multidrug therapy for Hansen’s disease and is generally well tolerated; however, clinically significant adverse reactions may occur in susceptible patients. This case report describes a 54-year-old female patient with Hansen’s disease who developed systemic symptoms and biochemical evidence of liver injury while receiving dapsone-containing multidrug therapy. She presented with high-grade fever with chills, pruritic skin lesions over the upper limbs, breathlessness, body pain, epigastric pain and jaundice. Clinical examination revealed hypotension and tachycardia, while laboratory evaluation showed severe anaemia, leucopenia, hyperbilirubinaemia, raised hepatic transaminases, low total protein and hypoalbuminaemia. Peripheral smear examination demonstrated severe microcytic hypochromic anaemia with leucopenia. Based on the temporal relationship between drug exposure and symptom onset, clinical presentation, laboratory abnormalities and improvement after withdrawal of the suspected drug, dapsone-induced liver injury associated with a hypersensitivity reaction was considered. Dapsone was discontinued immediately, and supportive management was initiated with intravenous fluids, antiemetics, proton pump inhibitor therapy, nutritional supplementation, antibiotics and N-acetylcysteine. The patient was subsequently discharged on an alternative anti-leprosy regimen consisting of rifampicin, clofazimine and ofloxacin, along with supportive medications. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 7, indicating a probable adverse drug reaction. This case highlights the need for careful clinical observation and laboratory monitoring in patients receiving dapsone-containing therapy. Early recognition of fever, rash, jaundice or unexplained haematological abnormalities is essential to prevent further complications and ensure timely modification of treatment.