Dapsone Induced Hypersensitivity Syndrome: A Rare Case Report

Dapsone, a sulfone antibiotic, is a key component of WHO-recommended multidrug therapy (MDT) for leprosy. Despite its therapeutic value, it can cause severe adverse reactions, including Dapsone Hypersensitivity Syndrome (DHS), a rare but potentially fatal condition characterized by fever, rash, and systemic organ involvement. A 20-year-old male with borderline tuberculoid leprosy was started on MDT. After 3 weeks, he developed fever, generalized exfoliative dermatitis, weakness, pedal edema, and jaundice. On examination, he was pale, tachypnoeic, febrile, tachycardic, and jaundiced, with hepatomegaly but no lymphadenopathy. Skin showed diffuse scaling without ulceration. Laboratory investigations revealed anemia (Hb 11 g/dl), markedly elevated AST and ALT, hypoalbuminemia, and hyperbilirubinemia. Viral hepatitis, HIV, and malaria were excluded. Abdominal ultrasound confirmed hepatomegaly and splenomegaly with otherwise normal findings.MDT was discontinued, and intravenous dexamethasone was initiated, followed by oral prednisolone tapering. Supportive therapy included paracetamol, vitamins, fluids, and antibiotics. The patient showed clinical improvement with resolution of fever and skin changes, and normalization of laboratory parameters. He was discharged after 2 weeks.