Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis

ABSTRACT

<p><b>INTRODUCTION</b>A 22-year-old Malay soldier developed dapsone hypersensitivity syndrome 12 weeks after taking maloprim (dapsone 100 mg/pyrimethamine 12.5 mg) for anti-malarial prophylaxis.</p><p><b>CLINICAL PICTURE</b>He presented with fever, rash, lymphadenopathy and multiple-organ involvement including serositis, hepatitis and thyroiditis. Subsequently, he developed congestive heart failure with a reduction in ejection fraction on echocardiogram, and serum cardiac enzyme elevation consistent with a hypersensitivity myocarditis.</p><p><b>TREATMENT</b>Maloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor.</p><p><b>OUTCOME</b>He has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission.</p><p><b>CONCLUSION</b>In summary, we report a case of dapsone hypersensitivity syndrome with classical symptoms of fever, rash and multi-organ involvement including a rare manifestation of myocarditis. To our knowledge, this is the first case of dapsone-related hypersensitivity myocarditis not diagnosed in a post-mortem setting. As maloprim is widely used for malaria prophylaxis, clinicians need to be aware of this unusual but potentially serious association.</p>