1
|
Ansah R, Arkoh EA, Quao BO, Groger M. Lack of Suspicion of Dapsone Hypersensitivity Syndrome in a Leprosy Patient: Case Report with Fatal Outcome. Res Rep Trop Med 2023; 14:135-139. [PMID: 38170098 PMCID: PMC10759403 DOI: 10.2147/rrtm.s434947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Background Dapsone is an antibiotic used in the management of leprosy. Following the worldwide adoption of the dapsone-containing multidrug therapy for treating leprosy, an upsurge in the reported frequency of dapsone hypersensitivity syndrome (DHS) has been observed. DHS is associated with a high fatality rate among patients from low-resourced settings and patients with syndrome-associated hepatitis. Case Presentation This is a case of a Ghanaian male who, while being treated for leprosy with the multidrug therapy, developed exfoliative dermatitis and signs of liver damage, 6 weeks after treatment initiation. He was managed for dapsone-related exfoliative dermatitis and infectious causes of liver damage were investigated. However, the patient's condition rapidly deteriorated with a fatal outcome despite discontinuation of dapsone. DHS was only considered as a differential diagnosis postmortem. Conclusion This case highlights the importance of having a high index of suspicion for DHS in all patients on dapsone and the need for a thorough workup for all leprosy patients who present with exfoliative dermatitis and signs of liver involvement within the latency period of the syndrome, especially in low resource settings. Furthermore, it stresses the need for prompt and appropriate treatment as DHS can quickly become fatal in such settings.
Collapse
Affiliation(s)
- Ruth Ansah
- Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Benedict Okoe Quao
- Ankaful Leprosy / General Hospital, Ankaful, Central Region, Ghana
- National Leprosy Control Program, Ghana Health Service, Accra, Ghana
| | - Mirjam Groger
- Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Jiang H, Wang CW, Wang Z, Dai Y, Zhu Y, Lee YS, Cao Y, Chung WH, Ouyang S, Wang H. Functional and structural characteristics of HLA-B*13:01-mediated specific T cells reaction in dapsone-induced drug hypersensitivity. J Biomed Sci 2022; 29:58. [PMID: 35964029 DOI: 10.1186/s12929-022-00845-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe cutaneous adverse drug reactions (SCARs) are a group of serious clinical conditions caused by immune reaction to certain drugs. The allelic variance of human leukocyte antigens of HLA-B*13:01 has been strongly associated with hypersensitivities induced by dapsone (DDS). T-cell receptor mediated activation of cytotoxic T lymphocytes (CTLs) has also been suggested to play an essential role in pathogenesis of SCARs. However, HLA-B*13:01-DDS-TCR immune synapse that plays role in drug-induced hypersensitivity syndrome (DIHS) associated T cells activation remains uncharacterized. METHODS To investigate the molecular mechanisms for HLA-B*13:01 in the pathogenesis of Dapsone-induced drug hypersensitivity (DDS-DIHS), we performed crystallization and expanded drug-specific CTLs to analyze the pathological role of DDS-DIHS. RESULTS Results showed the crystal structure of HLA-B*13:01-beta-2-microglobulin (β2M) complex at 1.5 Å resolution and performed mutation assays demonstrating that I118 or I119, and R121 of HLA-B*13:01 were the key residues that mediate the binding of DDS. Subsequent single-cell TCR and RNA sequencing indicated that TCRs composed of paired TRAV12-3/TRBV28 clonotype with shared CDR3 region specifically recognize HLA-B*13:01-DDS complex to trigger inflammatory cytokines associated with DDS-DIHS. CONCLUSION Our study identified the novel p-i-HLA/TCR as the model of interaction between HLA-B*13:01, DDS and the clonotype-specific TCR in DDS-DIHS.
Collapse
|
3
|
Franco-Paredes C, Garcia-Creighton E, Henao-Martínez A, Kallgren DL, Banjade R, Dyer JA, Nelson T, Zaesim A, Peluso MJ, Jain V, Lee DH, Minces LR, Wirshup M, Sierra Hoffman M, Katsolis J, Brust K, Giron J, Smiarowski L, Hoosepian-Mer PA, Stryjewska B. Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States. Ther Adv Infect Dis 2022; 9:20499361221135885. [PMID: 36387060 PMCID: PMC9647311 DOI: 10.1177/20499361221135885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/12/2022] [Indexed: 09/05/2023] Open
Abstract
The World Health Organization (WHO) recommends multidrug therapy (MDT) for the treatment of paucibacillary and multibacillary forms of leprosy, also known as Hansen's disease (HD). MDT combinations of dapsone, rifampin, and clofazimine have reduced the prevalence of the disease but are not without adverse effects impacting regimen adherence. Hence, an urgent need exists to consider alternative MDT regimens with an improved safety profile that promotes treatment adherence. Herein, we described a case series of 10 patients with HD (nine patients with multibacillary leprosy and one with pure neural leprosy) treated with monthly rifampin, moxifloxacin, and minocycline (RMM). The United States National Hansen's Disease Program (NHDP) diagnosed and treated patients across US institutions. All patients received a regimen of 12-24 months of RMM. We reviewed the clinical outcomes, adherence, rate of completion, and adverse events of patients treated with monthly RMM from January 2019 to August 2022. Nine patients had multibacillary leprosy, with some having type-2 reactions. One patient had pure neural leprosy with a reversal reaction. In this case series, we identified that all patients completed the RMM regimen without treatment interruptions. None of the patients experienced any skin hyperpigmentation or any significant side effects. All patients tolerated the monthly RMM regimen with rapid improvement of skin lesions and without logistic hurdles. Based on previous clinical evidence and the results of this case series, the NHDP and other programs should consider the RMM regimen as first-line therapy.
Collapse
Affiliation(s)
- Carlos Franco-Paredes
- Hospital Infantil de Mexico, Federico Gomez,
Mexico City 06720, Mexico
- Division of Infectious Diseases, University of
Colorado, Anschutz Medical Campus, Denver, CO, USA
| | | | - Andrés Henao-Martínez
- Division of Infectious Diseases, University of
Colorado, Anschutz Medical Campus, Denver, CO, USA
| | | | - Rashmi Banjade
- Department of Medicine, Division of Infectious
Diseases and Epidemiology, Penn State M.S. Hershey Medical Centre, Penn
State College of Medicine, Hershey, PA, USA
| | | | | | | | - Michael J. Peluso
- Division of HIV, Infectious Diseases &
Global Medicine, Zuckerberg San Francisco General Hospital, University of
California, San Francisco, San Francisco, CA, USA
| | - Vivek Jain
- Division of HIV, Infectious Diseases &
Global Medicine, Zuckerberg San Francisco General Hospital, University of
California, San Francisco, San Francisco, CA, USA
| | - Dong Heun Lee
- Department of Medicine, Division of Infectious
Diseases, University of California, San Francisco, San Francisco, CA,
USA
| | - Lucio R. Minces
- Infectious Disease, Carris Health
(CentraCare), Willmar, MN, USA
| | - Mary Wirshup
- Community Volunteers in Medicine, West
Chester, PA, USA
| | - Miguel Sierra Hoffman
- Infectious Disease Department and
Pulmonary
- Department, Texas A&M Victoria Campus, and
Family Medicine Residency Program, Victoria, TX, USA
| | - Jenn Katsolis
- St. Vincent’s Infectious Disease Specialists,
Jacksonville, FL, USA
| | - Karen Brust
- Division of Infectious Diseases, Department of
Internal Medicine, University of Iowa Carver College of Medicine, Iowa City,
IA, USA
| | - Jose Giron
- Sunshine Specialty Health Care and Florida
State University, College of Medicine, Tallahassee, FL, USA
| | - Lauren Smiarowski
- Sunshine Specialty Health Care and Florida
State University, College of Medicine, Tallahassee, FL, USA
| | | | - Barbara Stryjewska
- National Hansen’s Disease Program (NHDP), 9181
Interline Avenue, Baton Rouge, LA 70809, USA
| |
Collapse
|
4
|
Satapornpong P, Pratoomwun J, Rerknimitr P, Klaewsongkram J, Nakkam N, Rungrotmongkol T, Konyoung P, Saksit N, Mahakkanukrauh A, Amornpinyo W, Khunarkornsiri U, Tempark T, Wantavornprasert K, Jinda P, Koomdee N, Jantararoungtong T, Rerkpattanapipat T, Wang CW, Naisbitt D, Tassaneeyakul W, Ariyachaipanich M, Roonghiranwat T, Pirmohamed M, Chung WH, Sukasem C. HLA-B*13 :01 Is a Predictive Marker of Dapsone-Induced Severe Cutaneous Adverse Reactions in Thai Patients. Front Immunol 2021; 12:661135. [PMID: 34017337 PMCID: PMC8130671 DOI: 10.3389/fimmu.2021.661135] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 01/25/2023] Open
Abstract
HLA-B*13:01 allele has been identified as the genetic determinant of dapsone hypersensitivity syndrome (DHS) among leprosy and non-leprosy patients in several studies. Dapsone hydroxylamine (DDS-NHOH), an active metabolite of dapsone, has been believed to be responsible for DHS. However, studies have not highlighted the importance of other genetic polymorphisms in dapsone-induced severe cutaneous adverse reactions (SCAR). We investigated the association of HLA alleles and cytochrome P450 (CYP) alleles with dapsone-induced SCAR in Thai non-leprosy patients. A prospective cohort study, 16 Thai patients of dapsone-induced SCARs (5 SJS-TEN and 11 DRESS) and 9 Taiwanese patients of dapsone-induced SCARs (2 SJS-TEN and 7 DRESS), 40 dapsone-tolerant controls, and 470 general Thai population were enrolled. HLA class I and II alleles were genotyped using polymerase chain reaction-sequence specific oligonucleotides (PCR-SSOs). CYP2C9, CYP2C19, and CYP3A4 genotypes were determined by the TaqMan real-time PCR assay. We performed computational analyses of dapsone and DDS-NHOH interacting with HLA-B*13:01 and HLA-B*13:02 alleles by the molecular docking approach. Among all the HLA alleles, only HLA-B*13:01 allele was found to be significantly associated with dapsone-induced SCARs (OR = 39.00, 95% CI = 7.67–198.21, p = 5.3447 × 10−7), SJS-TEN (OR = 36.00, 95% CI = 3.19–405.89, p = 2.1657 × 10−3), and DRESS (OR = 40.50, 95% CI = 6.38–257.03, p = 1.0784 × 10−5) as compared to dapsone-tolerant controls. Also, HLA-B*13:01 allele was strongly associated with dapsone-induced SCARs in Asians (OR = 36.00, 95% CI = 8.67–149.52, p = 2.8068 × 10−7) and Taiwanese (OR = 31.50, 95% CI = 4.80–206.56, p = 2.5519 × 10−3). Furthermore, dapsone and DDS-NHOH fit within the extra-deep sub pocket of the antigen-binding site of the HLA-B*13:01 allele and change the antigen-recognition site. However, there was no significant association between genetic polymorphism of cytochrome P450 (CYP2C9, CYP2C19, and CYP3A4) and dapsone-induced SCARs (SJS-TEN and DRESS). The results of this study support the specific genotyping of the HLA-B*13:01 allele to avoid dapsone-induced SCARs including SJS-TEN and DRESS before initiating dapsone therapy in the Asian population.
Collapse
Affiliation(s)
- Patompong Satapornpong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.,Division of General Pharmacy Practice, Department of Pharmaceutical Care, College of Pharmacy, Rangsit University, Pathum Thani, Thailand
| | - Jirawat Pratoomwun
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.,Department of Clinical Chemistry, Faculty of Medical Technology, Huachiew Chalermprakiet University, Samut Prakan, Thailand
| | - Pawinee Rerknimitr
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand.,Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jettanong Klaewsongkram
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand.,Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nontaya Nakkam
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thanyada Rungrotmongkol
- Biocatalyst and Environmental Biotechnology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand.,Program in Bioinformatics and Computational Biology, Graduated School, Chulalongkorn University, Bangkok, Thailand
| | | | - Niwat Saksit
- Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Warayuwadee Amornpinyo
- Division of Dermatology, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - Therdpong Tempark
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Pimonpan Jinda
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Napatrupron Koomdee
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Thawinee Jantararoungtong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Ticha Rerkpattanapipat
- Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital (CGMH), Taipei, Taiwan.,Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Dean Naisbitt
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, United Kingdom
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital (CGMH), Taipei, Taiwan.,Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China.,Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan.,Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand.,The Thai Severe Cutaneous Adverse Drug Reaction (THAI-SCAR) Research Group, Bangkok, Thailand
| |
Collapse
|
5
|
Shrestha S, Danekhu K, KC B, Palaian S, Ibrahim MIM. Bibliometric analysis of adverse drug reactions and pharmacovigilance research activities in Nepal. Ther Adv Drug Saf 2020; 11:2042098620922480. [PMID: 32587678 PMCID: PMC7294481 DOI: 10.1177/2042098620922480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Bibliometric analyses have been used previously to study the measures of quality and impact of research performed in several health-related areas such as adverse drug reactions (ADRs) and pharmacovigilance (PV), etc. This method can assess the research performance of publications quantitatively and statistically. There is no evidence of bibilometric studies analyzing ADRs and PV from Nepal. Therefore, the present study aimed to assess scientific output on ADRs and PV-related research activities in Nepal using a bibliometric analysis of publications from 2004 January to December 2018, that is, 15 years. Methods: A systematic search was conducted in PubMed, Web of Science, Google Scholar, Scopus and Nepal Journal Online (NepJOL) databases. ‘Adverse Drug Reactions‘ or ‘ADRs‘ or ‘ADR‘ or ‘Adverse drug reaction‘ or ‘AE‘ or ‘Adverse Event‘ or ‘Drug-Induced Reaction‘ or ‘Pharmacovigilance‘ or ‘PV‘ and ‘Nepal‘. The search covered 15 years (January 2004 to December 2018) of study on ADRs and PV in Nepal. Only articles retrieved from databases were included, whereas published/unpublished drug bulletins, pharmacy newsletters and thesis were excluded. The articles thus retrieved were recorded, and thereafter analyzed. Word count code was used for the analysis of keywords used in the retrieved articles. Results: A total of 124 articles were retrieved, with the highest rate of publications in 2006 and 2007, with 16 papers each. Among the articles, 10 (8.1%) were published in Kathmandu University Medical Journal (KUMJ). Single papers were published in 38 different journals. Brief reports (1.6%), case reports (31.2%), case series (0.8%), education forums (0.8%), letters to the editor (5.6%), original research articles (41.9%), review articles (9.7%), short communications and short reports (8.1%) on ADRs and PV were recorded. Out of 124 papers, 52 (41.9%) were original research publications. The majority (74.1%) of research was done in the category of ADR incidence, types, prevention, and management, followed by policy and suggestions for strengthening national and regional pharmacovigilance centers of Nepal (14.5%). Conclusions: During the study years, there was an increase in scientific publications on drug safety. A total of 124 published articles were found during bibliometric analysis of ADRs and PV research activities in Nepal.
Collapse
Affiliation(s)
| | - Krisha Danekhu
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | | |
Collapse
|
6
|
Liu H, Wang Z, Bao F, Wang C, Sun L, Zhang H, Yu G, Mi Z, Li J, Li L, Zhao Q, Yue Z, Zhao W, Yu W, Cao J, Xiong F, Wang Y, Chai Z, Cheng X, Zhang Y, Fu F, Lang X, Wang X, Irwanto A, Krismawati H, Fu X, Sun Y, You J, Liu J, Pan Q, Chu T, Liu D, Chen S, Shen J, Yan L, Zhang G, Liu J, Zhang F, Xiong L, Yang J, Li J, Ke W, Li M, Ning Y, Xiong J, Li M, Xiong M, Yang B, Duan Q, Wang H, Li W, Kuang Y, Li J, Wang L, Cao Q, Xiao P, Xiao B, Zhang L, Lin Z, Wang Y, Shen Y, Yan L, Wu W, Zheng H, Zhan X, Li W, Shang X, Xu Y, Liu Q. Evaluation of Prospective HLA-B*13:01 Screening to Prevent Dapsone Hypersensitivity Syndrome in Patients With Leprosy. JAMA Dermatol 2020; 155:666-672. [PMID: 30916737 DOI: 10.1001/jamadermatol.2018.5360] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Dapsone hypersensitivity syndrome (DHS) is the most serious adverse reaction associated with dapsone administration and one of the major causes of death in patients with leprosy, whose standard treatment includes multidrug therapy (MDT) with dapsone, rifampicin, and clofazimine. Although the HLA-B*13:01 polymorphism has been identified as the genetic determinant of DHS in the Chinese population, no studies to date have been done to evaluate whether prospective HLA-B*13:01 screening could prevent DHS by identifying patients who should not receive dapsone. Objective To evaluate the clinical use of prospective HLA-B*13:01 screening for reduction of the incidence of DHS by excluding dapsone from the treatment for patients with HLA-B*13:01-positive leprosy. Design, Setting, and Participants A prospective cohort study was conducted from February 15, 2015, to April 30, 2018, in 21 provinces throughout China. A total of 1539 patients with newly diagnosed leprosy were enrolled who had not received dapsone previously. After excluding patients who had a history of allergy to sulfones or glucose-6-phosphate dehydrogenase deficiency, 1512 individuals underwent HLA-B*13:01 genotyping. All of the patients were followed up weekly for the first 8 weeks after treatment to monitor for adverse events. Exposures Patients who were HLA-B*13:01 carriers were instructed to eliminate dapsone from their treatment regimens, and noncarrier patients received standard MDT. Main Outcomes and Measures The primary outcome was the incidence of DHS. The historical incidence rate of DHS (1.0%) was used as a control. Results Among 1512 patients (1026 [67.9%] men, 486 [32.1%] women; mean [SD] age, 43.1 [16.2] years), 261 (17.3%) were identified as carriers of the HLA-B*13:01 allele. A total of 714 adverse events in 384 patients were observed during the follow-up period. Dapsone hypersensitivity syndrome did not develop in any of the 1251 patients who were HLA-B*13:01-negative who received dapsone, while approximately 13 patients would be expected to experience DHS, based on the historical incidence rate of 1.0% per year (P = 2.05 × 10-5). No significant correlation was found between other adverse events, including dermatologic or other events, and HLA-B*13:01 status. Conclusions and Relevance Prospective HLA-B*13:01 screening and subsequent elimination of dapsone from MDT for patients with HLA-B*13:01-positive leprosy may significantly reduce the incidence of DHS in the Chinese population.
Collapse
Affiliation(s)
- Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, Chinakrismawati.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Zhenzhen Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Fangfang Bao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Chuan Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Lele Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Huimin Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Gongqi Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Zihao Mi
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Jianke Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Lulu Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Qing Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Zhenhua Yue
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Wei Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Wenjun Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Jing Cao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Fei Xiong
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Yaru Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Zemin Chai
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Xiujun Cheng
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Yuan Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Fanghui Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Xiaoqiao Lang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Xiaoling Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Astrid Irwanto
- Human Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research of Singapore
| | - Hana Krismawati
- Papua Biomedical Research Center, National Institute for Health Research, Indonesian Ministry of Health, Jl Kesehatan 10, Dok II, Jayapura, Papua, Indonesia
| | - Xi'an Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Jiabao You
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Jian Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Qing Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Tongsheng Chu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Dianchang Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Shumin Chen
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Jianping Shen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu
| | - Liangbin Yan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu
| | - Guocheng Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research of Singapore
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Science, Jinan, Shandong, China.,Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, Chinakrismawati.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | | | - Li Xiong
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan
| | - Jun Yang
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan
| | - Jinlan Li
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou
| | - Wei Ke
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou
| | - Ming Li
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou
| | - Yong Ning
- Sichuan Provincial Institute of Dermatology, Chengdu, Sichuan
| | - Junhao Xiong
- Sichuan Provincial Institute of Dermatology, Chengdu, Sichuan
| | - Ming Li
- Guangdong Provincial Institute of Dermatology, Guangzhou, Guangdong
| | - Mingzhou Xiong
- Guangdong Provincial Institute of Dermatology, Guangzhou, Guangdong
| | - Bin Yang
- Guangdong Provincial Institute of Dermatology, Guangzhou, Guangdong
| | - Qizhi Duan
- Guangxi Provincial Institute of Dermatology, Nanning, Guangxi
| | - Hong Wang
- Guangxi Provincial Institute of Dermatology, Nanning, Guangxi
| | - Wei Li
- Guangxi Provincial Institute of Dermatology, Nanning, Guangxi
| | - Yanfei Kuang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan
| | - Junhua Li
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan
| | - Lamei Wang
- Jiangxi Provincial Institute of Parasitic Diseases, Nanchang, Jiangxi
| | - Qiuyang Cao
- Jiangxi Provincial Institute of Parasitic Diseases, Nanchang, Jiangxi
| | - Peng Xiao
- Chongqing Center for Disease Control and Prevention, Chongqing
| | - Bangzhong Xiao
- Chongqing Center for Disease Control and Prevention, Chongqing
| | - Lianhua Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu
| | - Zhaoxing Lin
- Shanxi Provincial Institute for Endemic Disease Control, Xi'an, Shanxi
| | - Yaofei Wang
- Shanxi Provincial Institute for Endemic Disease Control, Xi'an, Shanxi
| | - Yunliang Shen
- Zhejiang Provincial Institute of Dermatology, Huzhou, Zhejiang
| | - Liying Yan
- Zhejiang Provincial Institute of Dermatology, Huzhou, Zhejiang
| | - Wenbin Wu
- Fujian Center for Disease Control and Prevention, Fuzhou, Fujian
| | - Hu Zheng
- Anhui Provincial Institute of Dermatology, Hefei, Anhui
| | - Xianfa Zhan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei
| | - Wanghua Li
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei
| | - Xiujian Shang
- Xinjiang Center for Disease Control and Prevention, Urumchi, Xinjiang
| | - Yujun Xu
- Hainan Provincial Center for Skin Disease and STI Control, Haikou, Hainan
| | - Qiao Liu
- Hainan Provincial Center for Skin Disease and STI Control, Haikou, Hainan
| |
Collapse
|
7
|
Tangamornsuksan W, Lohitnavy M. Association Between HLA-B*1301 and Dapsone-Induced Cutaneous Adverse Drug Reactions: A Systematic Review and Meta-analysis. JAMA Dermatol 2019. [PMID: 29541744 DOI: 10.1001/jamadermatol.2017.6484] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Dapsone-induced hypersensitivity syndrome (DHS) is a life-threatening adverse drug reaction. Based on available epidemiologic studies, HLA genotypes may play an important role in DHS. Objective To assess the association between HLA-B*1301 and dapsone-induced cutaneous adverse drug reactions (cADRs). Data Sources Human studies investigating associations between HLA-B*1301 and dapsone-induced cADRs were systematically searched without language restriction from the inception of each database until September 12, 2017, in PubMed, the Human Genome Epidemiology Network), and the Cochrane Library. Combinations of HLA genotypes, dapsone, and synonymous terms were used; reference lists were searched in selected articles. Study Selection Two reviewers identified studies investigating the associations between HLA-B*1301 and dapsone-induced cADRs that reported sufficient data for calculating the frequency of HLA-B*1301 carriers among case and control patients, in which all patients received dapsone before HLA-B*1301 screening. An initial search of the databases identified 391 articles, of which 3 studies (2 in Chinese populations and 1 in a Thai population) met the inclusion criteria. Data Extraction and Synthesis Overall odds ratios (ORs) with 95% CIs were calculated using a random-effects model to determine the association between HLA-B*1301 and dapsone-induced cADRs. Subgroup analyses by type of cADR were also performed. PRISMA guidelines were used to abstract and assess data. Main Outcomes and Measures Primary outcomes were associations between HLA-B*1301 and dapsone-induced cADRs in dapsone-tolerant controls. The outcomes are reported as overall OR. Statistical heterogeneity was assessed using the Q statistic and I2 tests. Results From the 3 included studies, there were 111 unique patients with dapsone-induced cADRs (subsequently used in the meta-analysis), 1165 dapsone-tolerant patients, and 3026 healthy controls. The cases included 64 men and 49 women (2 patients were missing from the meta-analysis; 1 each from 2 of the 3 studies); mean age was 39.7 years. An association between HLA-B*1301 and dapsone-induced cADRs was identified (summary OR, 43.0; 95% CI, 24.0-77.2). Subgroup analyses among types of cADRs produced similar findings in DHS (OR, 51.7; 95% CI, 16.9-158.5), dapsone-induced severe cADRs (Stevens-Johnson syndrome and toxic epidermal necrolysis [SJS/TEN] plus drug rash [adverse skin reaction to a drug] along with eosinophilia and systemic symptoms [DRESS]) (OR, 54.0; 95% Cl, 8.0-366.2), dapsone-induced SJS/TEN (OR, 40.5; 95% CI, 2.8-591.0), and dapsone-induced DRESS (OR, 60.8; 95% CI, 7.4-496.2). There was no heterogeneity (I2 = 0%, P = .38). Conclusions and Relevance Associations between HLA-B*1301 and dapsone-induced cADRs were found in dapsone-tolerant and healthy control groups. For patient safety, genetic screening for HLA-B*1301 in Asian populations before dapsone therapy is warranted.
Collapse
Affiliation(s)
- Wimonchat Tangamornsuksan
- Center of Excellence for Environmental Health and Toxicology, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Manupat Lohitnavy
- Center of Excellence for Environmental Health and Toxicology, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Pharmacokinetic Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
8
|
de Nardo Vanzela T, Bernardes Filho F, Wambier CG, Faria FM, Foss NT, Frade MAC. Th17 Response of Borderline-Lepromatous Leprosy Inhibits Rash Manifestation of Dapsone Hypersensitivity Syndrome: Case Report. Am J Dermatopathol 2018; 40:205-8. [PMID: 28937434 DOI: 10.1097/DAD.0000000000000839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dapsone hypersensitivity syndrome (DHS) is a rare, but potentially life-threatening reaction to dapsone. OBJECTIVE Evaluation of immunological factors involved in the sparing of borderline-lepromatous (BL) leprosy patches by the severe exanthema related to DHS. METHODS The authors describe a 19-year-old man with borderline-lepromatous leprosy with a recent diffuse rash, sparing only the hypochromic patches of leprosy, generalized lymphadenopathy, hepatomegaly, and jaundice 25 days after the start of multibacillary multidrug therapy. RESULTS Laboratory testing was remarkable for leukocytosis with eosinophilia, atypical lymphocytosis, and elevated liver and canalicular enzymes. Immunohistopathology of the rash showed stronger expression of Th1 cytokines (IL1β, TNFα, IFNγ, and iNOS), and limited expression of IL17, TGFb, IL4, and IL10. Whereas the hypochromic leprosy patches showed high expression of inflammatory cytokines IL1β, TNFα, IFNγ, iNOS, and TGFβ (Th1), and presented strong expression of IL17 and TGFβ with no IL4 and IL10 expression, by the inflammatory infiltrate, characterizing a participation of Th17 response. CONCLUSION Th17 response, coupled with the presence of subepidermal collagen band, seems to be directly related to the absence of DHS rash in these hypochromic leprosy patches.
Collapse
|
9
|
Wang N, Parimi L, Liu H, Zhang F. A Review on Dapsone Hypersensitivity Syndrome Among Chinese Patients with an Emphasis on Preventing Adverse Drug Reactions with Genetic Testing. Am J Trop Med Hyg 2017; 96:1014-1018. [PMID: 28167593 PMCID: PMC5417189 DOI: 10.4269/ajtmh.16-0628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AbstractDapsone is a bactericidal and bacteriostatic against Mycobacterium leprae, a causative agent of leprosy. Dapsone is also applied in a range of medical fields because of its anti-inflammatory and immunomodulatory effects. Dapsone hypersensitivity syndrome (DHS) is a rare yet serious adverse drug reaction (ADR) caused by dapsone involving multiple organs. We performed a systematic review of published articles describing dapsone-induced hypersensitivity syndrome, including all Chinese articles and the latest literature available in online databases published between October 2009 and October 2015. We determined the prevalence, clinical characteristics, and mortality rate of DHS. Importantly, we also summarized the recent advances in genetic testing allowing prediction of ADRs. In an initial systematic electronic search, we retrieved 191 articles. Subsequently, these articles were further filtered and ultimately 84 articles (60 Chinese case reports, 21 non-Chinese articles, and three epidemiological studies) were selected, which included 877 patients. The prevalence of DHS among Chinese patients was 1.5% with a fatality rate of 9.6%. Early withdrawal of dapsone and appropriate treatment reduced the fatality rate. Most importantly, genetic screening for the HLA-B*13:01 allele among high-risk populations showed a significant utility as a useful genetic marker to DHS. In conclusion, this review discusses the epidemiological and clinical characteristics of DHS among Chinese patients, which may help physicians to understand this syndrome.
Collapse
Affiliation(s)
- Na Wang
- Department of Dermatology, Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, Shandong, China.,Department of Dermatology and Venereology, Shandong Provincial Institute of Dermatology and Venereology, Shandong University, Jinan, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Leela Parimi
- Department of Dermatology and Venereology, Shandong Provincial Institute of Dermatology and Venereology, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, Shandong, China
| | - Hong Liu
- Department of Dermatology and Venereology, Shandong Provincial Institute of Dermatology and Venereology, Shandong University, Jinan, China.,Department of Dermatology, Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Furen Zhang
- Department of Dermatology and Venereology, Shandong Provincial Institute of Dermatology and Venereology, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China.,Department of Dermatology, Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China
| |
Collapse
|
10
|
Affiliation(s)
- A Jayavardhana
- Department of Paediatrics, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India
| | - A M Vijayalakshmi
- Department of Paediatrics, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India
| |
Collapse
|
11
|
Abstract
Dapsone can cause several adverse effects, the most serious being dapsone hypersensitivity syndrome (DHS), which is potentially fatal. Here we report a case of severe, life threatening dapsone systemic hypersensitivity syndrome in a 17-year-old male who presented with high grade fever, eosinophilia, lymphadenopathy, skin rash, hepatitis and encephalopathy, which was managed successfully with oral steroids. The case is being reported to emphasize the need for timely diagnosis and prompt treatment of this rare complication for successful outcomes. DHS is also reviewed in brief.
Collapse
Affiliation(s)
- Kolar Vishwanath Vinod
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantrinagar, Puducherry, India
| | | | | |
Collapse
|
12
|
Wang H, Yan L, Zhang G, Chen X, Yang J, Li M, Shen J, Yu M, Huo R, Wang B. Association between HLA-B*1301 and dapsone-induced hypersensitivity reactions among leprosy patients in China. J Invest Dermatol 2013; 133:2642-2644. [PMID: 23604100 DOI: 10.1038/jid.2013.192] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hongsheng Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China.
| | - Liangbin Yan
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Guocheng Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Xiangsheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Jun Yang
- Yunnan Provincial CDC, Yunnan, China
| | - Ming Li
- Guangdong Provincial Dermatology Hospital, Guangdong, China
| | - Jianping Shen
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Meiwen Yu
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Ran Huo
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Baoxi Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China.
| |
Collapse
|
13
|
Sheen YS, Chu CY, Wang SH, Tsai TF. Dapsone hypersensitivity syndrome in non-leprosy patients: A retrospective study of its incidence in a tertiary referral center in Taiwan. J DERMATOL TREAT 2009; 20:340-3. [DOI: 10.3109/09546630802691317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Figtree MC, Miyakis S, Tanaka K, Martin L, Konecny P, Krilis S. Dapsone hypersensitivity syndrome causing disseminated intravascular coagulation. BMJ Case Rep 2009; 2009:bcr11.2008.1257. [PMID: 21829418 DOI: 10.1136/bcr.11.2008.1257] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dapsone hypersensitivity syndrome is an idiosyncratic reaction to this drug and can present with different clinical manifestations of varying severity. We describe a patient with disseminated intravascular coagulation (DIC) as an adverse reaction to dapsone. To the best of our knowledge, this is the first time it has been described in the literature. She presented with fever, rash and abdominal pain; she also had marked eosinophilia and features suggestive of oxidative haemolysis. Her course was complicated by DIC, splenic infarction and gastrointestinal bleeding. Extensive investigations did not reveal any alternative aetiology. She was initially treated with supportive measures and folic acid; steroids were administered later, following clinical deterioration. There was gradual improvement and the steroids were tapered. The patient recovered fully and remains well; her underlying chronic dermatologic condition is under satisfactory control with other medications.
Collapse
Affiliation(s)
- Melanie Clare Figtree
- St George Hospital, Immunology, Allergy and Infectious Disease, Kogarah, Sydney, New South Wales, 2217, Australia
| | | | | | | | | | | |
Collapse
|
15
|
Current World Literature. Curr Opin Allergy Clin Immunol 2008; 8:360-366. [DOI: 10.1097/aci.0b013e32830abac8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|