Dapsone hypersensitivity syndrome overlaps reversal reaction in leprosy patient
| Main Authors: | Chesia Christiani Liuwan; Department of Dermatovenereology Faculty of Medicine Airlangga University Dr.Soetomo General Hospital Surabaya, M. Yulianto Listiawan; Department of Dermatovenereology Faculty of Medicine Airlangga University Dr.Soetomo General Hospital Surabaya, Medhi Denisa; Department of Dermatovenereology Faculty of Medicine Airlangga University Dr.Soetomo General Hospital Surabaya |
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| Format: | application/pdf Journal |
| Bahasa: | eng |
| Terbitan: |
Universitas Indonesia
, 2019
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| Online Access: |
http://jgenprodvi.ui.ac.id/index.php/jdvi/article/view/119 |
Daftar Isi:
- Introduction: Leprosy, caused by Mycobacterium leprae, is a chronic granulomatous infectious disease that primarily involves the skin and peripheral nerve. The clinical features may vary depending on the patient’s immune response to the organism. An increase in immunity, manifesting as a reversal reaction, is common after treatment in patients with borderline leprosy. Dapsone hypersensitivity syndrome (DHS) is an adverse effect from dapsone therapy. This form of allergic reaction may occur in 5-6 weeks to 6 months after initial treatment in leprosy patient Case Illustration: A 47-year-old female came with a spreading redness of the skin patches on her trunk and extremities of three weeks duration. It was also followed by itch and tight sensation of rash. The patient experienced fever, pain, and numbness on the lesions. She was diagnosed with leprosy and had her 6th Multi Drug Therapy-Multi Bacillary (MDT-MB) regimen. Physical examination on the thoracic, abdominal, and extremities region found multiple erythematous macules with hypoesthesia, sharply marginated ranging from 3 to 5 cm in size along with discrete erythematous papules. The bacteriology index was zero. The patient was diagnosed with borderline leprosy with reversal reaction. We managed to give prednisone and the patches became better, but the rash was still progressive. After stopping dapsone at the 9th MDT-MB regimen, the rash had gotten significantly better. Discussion: Borderline leprosy is immunologically unstable and can be complicated by reversal reactions. Reversal reaction is a sign of increasing immunity and usually occurs after having some MDT treatment. DHS is a rare adverse reaction followed by fever, skin rash, lymphadenopathy, hepatitis and other systemic features with the history of exposure to dapsone treatment. Conclusion: Reversal reaction got better with prednisone, while DHS was significantly improved after stopping dapsone therapy, as shown by the reduction of rash. Drug patch test should be conducted after the lesion resolve in order to establish DHS. Keywords: dapsone hypersensitivity syndrome, leprosy, reversal reaction