Severe adverse reaction to dapsone in the treatment of leprosy

Abstract

Introduction: leprosy is caused by the bacillus Mycobacterium leprae and affects the skin and/or peripheral nerves. Adverse reactions to medications used in the treatment of the disease have been reported in the literature. Objective: to report the case of a patient who experienced a severe adverse reaction to dapsone in the treatment of leprosy. Case description: a 51-year-old female patient sought care at the dermatology outpatient clinic of Lauro Wanderley University Hospital of the Federal University of Paraíba, linked to the Brazilian Hospital Services Company, complaining of spots on her lower limbs for three years. Physical examination revealed erythematous-brown macules with altered sensitivity in the lower limbs. A biopsy of the lesions and a skin smear bacilloscopy were performed, confirming the diagnosis of leprosy, leading to the initiation of multidrug therapy, single regimen. After three weeks, the patient developed hemolytic anemia caused by dapsone, necessitating the suspension of multidrug therapy, single regimen, and the prescription of two hemoconcentrates and intravenous hydrocortisone, with satisfactory progress. Discussion: there are reports in the literature of adverse reactions to multidrug therapy, single regimen, with an emphasis on dapsone. Hemolytic anemia is one of the most common adverse effects. However, the patient’s low hemoglobin levels differed from findings in previous studies, making it necessary to suspend the medications. Conclusions: the case highlights severe anemia, emphasizing the relevance of an interdisciplinary approach and meticulous attention to patients undergoing such therapeutic regimens.