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Dapsone-Induced Sulfone Syndrome

Clinical Specialist, Antimicrobial Management Team, Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians, Richmond, VA

Trisha B Nashed, MD

Fellow, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians

Reprints: Kimberly B Lee PharmD BCPS, PO Box 980042, Virginia Commonwealth University/Medical College of Virginia, Richmond, VA 23298-0042, FAX 804/225-3920, E-mail kblee{at}hsc.vcu.edu

OBJECTIVE: To report a patient with dapsone-induced sulfone syndrome.

CASE SUMMARY: A 42-year-old HIV-infected African American man developed fever, lymphadenopathy, exfoliative dermatitis, hepatitis, and methemoglobinemia 4 weeks after starting dapsone. Complete resolution of symptoms and laboratory abnormalities occurred with cessation of dapsone therapy.

DISCUSSION: Sulfone syndrome is not a well-known sequela of dapsone therapy. It is not dose-related, usually occurs in doses of 50–300 mg/d, all cases occur within 2 months of starting dapsone, all patients have fever, and most patients will develop rash and evidence of hepatic injury. The temporal relationship between dapsone therapy and onset of clinical symptoms and objective data led us to believe that dapsone caused sulfone syndrome in our patient. An objective causality assessment revealed that the adverse drug event was probable.

CONCLUSIONS: Although sulfone syndrome appears to be relatively uncommon, healthcare practitioners must be aware of the potentially fatal syndrome associated with dapsone use.

Key Words: dapsone, hepatitis, methemoglobinemia, sulfone syndrome

Published Online, May 23, 2003. www.theannals.com, DOI 10.1345/aph.1C432

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