Hemolytic Anemia Associated with Dapsone Therapy in Pemphigus Foliaceus: A Case Report

Abstract

Background: Dapsone is frequently used as a steroid-sparing agent in autoimmune blistering disorders such as pemphigus foliaceus. Although generally well tolerated, dapsone can rarely cause serious hematological adverse effects, including hemolytic anemia, which may be life-threatening if not recognized early. Case Presentation: We report the case of a 34-year-old female with a long-standing history of pemphigus foliaceus and hypothyroidism who developed severe hemolytic anemia during dapsone therapy. The patient presented with generalized weakness, dyspnea, cough, and reduced appetite. Laboratory investigations revealed markedly reduced hemoglobin levels, elevated reticulocyte count, increased lactate dehydrogenase, and indirect hyperbilirubinemia, consistent with active hemolysis. Direct Coombs test was positive, supporting the diagnosis of autoimmune hemolytic anemia. Based on clinical presentation, laboratory findings, and a probable causality score on the Naranjo adverse drug reaction probability scale, dapsone-induced hemolytic anemia was diagnosed. Dapsone was immediately discontinued, and the patient was managed with systemic corticosteroids, packed red blood cell transfusion, and supportive care, resulting in gradual clinical and hematological improvement, resulting in gradual clinical and hematological improvement. Conclusion: This case highlights a rare but severe adverse drug reaction associated with dapsone therapy in pemphigus foliaceus. It underscores the importance of baseline evaluation, regular hematological monitoring, and early recognition of hemolytic complications in patients receiving dapsone. Clinicians should remain vigilant and consider safer alternative therapies in high-risk individuals to prevent potentially fatal outcomes.