Journal of Clinical Toxicology
Open Access

Abstract

The Day Dapsone DRESSed as DILI

Lee B Sigmon, Tom De Roche and Herbert Bonkovsky

Dapsone is a diaminodiphenylsulfone drug approved to treat leprosy with off-label use in HIV. It is a rare cause of idiosyncratic liver injury and has been associated with hypersensitivity. The pattern of liver injury is typically cholestatic, and the development of cholestasis due to dapsone has been described in rats. Here we describe a case of intrahepatic cholestasis and hypersensitivity syndrome in a patient with AIDS after initiation of dapsone for Pneumocystis pneumonia. The patient was admitted from clinic for scleral icterus of 3 days duration. He was febrile, hypotensive, and tachycardic with scleral icterus, jaundice, and a patchy erythematous rash on the torso. Laboratory studies showed eosinophilia and cholestatic injury pattern with value of R=0.5. All anti-retroviral medications and dapsone were stopped. Given concern for immune reconstitution in this AIDS patient, a liver biopsy was performed which was consistent with drug induced liver injury. Anti-retroviral therapy was re-started and the patient’s aminotransferases and bilirubin gradually improved over span of 8 weeks following discontinuation of dapsone.