Case Report
Year: 2019 | Month: July | Volume: 9 | Issue: 7 | Pages: 293-297
A Case Report of Fatal Dapsone-Induced Agranulocytosis in an Indian Tuberculoid Leprosy Patient
Samaga Shreyas1, Bhandary NM2
1Junior resident, 2Associate Professor
Department of General Medicine, AJ Institute of Medical Sciences, Mangalore
Corresponding Author: Samaga Shreyas
ABSTRACT
Introduction: Being one of the oldest diseases known to mankind, leprosy continues to be a public health challenge. Dapsone continues to be the drug used against this since time immemorial. The most common side effects of dapsone are hemolytic anaemia, methemoglobinemia and agranulocytosis. We report a case of dapsone-induced agranulocytosis in a patient being initiated with leprosy therapy.
History: A 56 year old female presented with fever and non productive cough with no other known co-morbidities. Examination revealed enlarged erythematous tonsils and cervical lymphadenopathy in a pale female. After three days of hospital care, attenders confessed about the treatment taken for Hansen’s disease since 2 weeks and her present complaints started after starting the treatment. Her WBC counts were low and absolute neutrophil count was 780cells/mm3. She was managed with antibiotics, and G-CSF. Dapsone was stopped and the WBC counts increased, patient improved clinically.
Conclusion: Sound knowledge of the drugs that can cause agranulocytosis is essential. Identifying the offending drug by meticulous history taking and clinical examination to look for sites of skin biopsy/ skin lesions might help in identifying the offending drug. Stopping the use of the offending drug, careful monitoring of blood counts, isolation of the patient to avoid contact of infections, hand hygiene, use of Granulocyte colony stimulating factors till white blood counts recover to more than 10,000/microL are all integral part of patient management and to prevent impending sepsis and death.
Key words: Dapsone, agranulocytosis, Leprosy, G-CSF