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The Annals of Pharmacotherapy: Vol. 37, No. 10, pp. 1438-1440. DOI 10.1345/aph.1C482
© 2003 Harvey Whitney Books Company.
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Dapsone-Induced Acute Pancreatitis

Shivkumar H Jha, MD

Post-Doctoral Fellow, Department of Pharmacology and Psychiatry, School of Medicine, Boston University, Boston, MA

Jyothi A Reddy, MD FACG FACP

Clinical Assistant Professor in Internal Medicine, College of Medicine, University of Illinois at Urbana–Champaign, Champaign, IL; Danville Veterans Affairs Hospital, Danville, IL

Jatin K Dave, MD

at time of writing, Resident, Internal Medicine, College of Medicine, University of Illinois at Urbana–Champaign; Danville Veterans Affairs Hospital; now, Geriatric Fellow, Harvard University, Boston, MA

Reprints: Shivkumar H Jha MD, Department of Pharmacology, School of Medicine, Boston University, 715 Albany St., L 601 B, Boston, MA 02118-2526, FAX 617/638-5254, jha{at}bu.edu

OBJECTIVE:To report a case of acute pancreatitis associated with dapsone use.

CASE SUMMARY: An 87-year-old white man was prescribed dapsone for dermatitis herpetiformis. Four weeks later, he developed acute abdominal pain requiring hospitalization. The patient had elevated serum amylase and lipase levels. Laboratory test results for other possible etiologies were negative. His symptoms resolved when dapsone was discontinued. Dapsone was reintroduced for exacerbation of dermatitis herpetiformis 4 months later. The patient again had severe abdominal pain with high amylase and lipase levels. Again, symptoms resolved following dapsone discontinuation.

DISCUSSION:Only 1 other case of pancreatitis associated with dapsone was found in a MEDLINE search of the literature (1966–June 2003) using the key terms dapsone and pancreatitis. An objective causality assessment revealed dapsone to be a probable cause of acute pancreatitis, based on the Naranjo probability scale. Drugs should always be considered as causative factors for pancreatitis in patients without known risk factors. Dapsone is increasingly used as a second line of treatment of Pneumocystis cariniipneumonia (PCP). The recognition of dapsone-induced pancreatitis is of particular importance in these patients.

CONCLUSIONS:While dapsone is traditionally used for the treatment of leprosy and dermatitis herpetiformis, its use for PCP prophylaxis, malaria, brown recluse spider bites, and acne is not uncommon. Pancreatitis is an uncommon adverse effect of dapsone, and greater awareness of this association will prompt a high index of suspicion in an appropriate clinical setting. Further reporting of cases and clinical research of drug-induced pancreatitis is indicated.

Key Words: dapsone, pancreatitis

Published Online, July 25, 2003. www.theannals.com, DOI 10.1345/aph.1C482




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