SHM Converge Scientific Abstract ePoster Gallery-A Rare Drug Reaction: A Case of Dapsone Hypersensitivity Syndrome

Pdf Summary

This case report describes dapsone hypersensitivity syndrome (DHS), a rare but potentially fatal immune-mediated reaction related to DRESS. DHS typically appears 4–6 weeks after starting dapsone and can cause fever, rash, eosinophilia, hemolytic anemia, and multiorgan injury, especially severe liver dysfunction. Mortality is estimated at about 10%, making early recognition critical. HLA-B*13:01 is a major genetic risk factor.<br /><br />The patient was a 22-year-old woman treated with dapsone for macular lymphocytic arteritis. About one month later, she developed fever, abdominal pain, vomiting, and fatigue. Initial evaluation showed Coombs-negative hemolytic anemia and marked liver injury with elevated AST, ALT, bilirubin, and INR. Infectious, autoimmune, and metabolic workups were unrevealing, and her condition worsened enough to require transfer to a liver transplant center.<br /><br />As her illness progressed, eosinophilia developed later and she also developed erythematous plaques on her arms. The combination of recent dapsone exposure, fever, delayed eosinophilia, rash, hemolysis, and mixed hepatocellular/cholestatic liver injury strongly suggested DHS. Liver biopsy showed severe acute necro-inflammatory injury with eosinophils, and skin biopsy supported the diagnosis. Her course was consistent with probable drug-induced liver injury.<br /><br />Management centered on stopping dapsone immediately and starting systemic corticosteroids, after which her laboratory values and clinical status improved.<br /><br />Key lessons: DHS may begin with nonspecific symptoms before the classic triad fully appears; eosinophilia can be delayed; liver injury and Coombs-negative hemolytic anemia are important clues; and prompt drug withdrawal plus glucocorticoids can be lifesaving. Patients should also be monitored for delayed autoimmune complications, such as thyroiditis.

Asset Subtitle

Anjali Davichan

Meta Tag

Author List Anjali Davichan, Sagah Ahmed

Category Clinical Vignettes

Concept Drug-Induced Hypersensitivity Syndrome

Concept Dapsone

Concept Dapsone Discontinuation

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Hepatocellular Injury

Distinguished Non-Finalist

Presenter Organization Mary Washington Hospital

Presenting Author Anjali Davichan

Track Adult

Keywords

dapsone hypersensitivity syndrome

DRESS

hemolytic anemia

eosinophilia

liver injury

drug-induced liver injury

corticosteroids

HLA-B*13:01

rash

multiorgan injury

Drug-Induced Hypersensitivity Syndrome

Dapsone

Dapsone Discontinuation

Drug Reaction with Eosinophilia and Systemic Symptoms

Hepatocellular Injury