Dapsone-Induced Isolated Acute Pancreatitis in a Child with Linear IgA Dermatitis

To the Editor: Dapsone has long been used to treat leprosy. Nowadays, it is also used in the treatment of a variety diseases. Many side effects have been described, the most frequent at pediatric age being methemoglobinemia [1, 2]; other side effects include Dapsone hypersensitivity syndrome (DHS) [1]. To date, only three cases of isolated acute pancreatitis have been described with the use of Dapsone [1, 3]. A boy, aged 3 y and 5 mo presented with vomiting and abdominal pain for 48 h. Linear IgA dermatitis had been diagnosed at two and a half years of age, and had been well controlled with Dapsone (18 mg/d). He had two previous admissions with similar symptoms improving after Dapsone withdrawal. Physical examination showed diffuse abdominal pain, with no signs of peritoneal irritation. A complete blood cell count and coagulation profile were normal. Serum chemistries showed: C-reactive protein 32.9 mg/dL; pancreatic amylase 236 IU/L [normal: 60–80 UI/L]; lipase 318 IU/L [normal: 23–250 UI/L]; total calcium, hepatic profile, electrolytes, glucose, lipid profile, urea and serum creatinine within normal limits. Infections and celiac disease were dismissed. Abdominal ultrasound revealed diffuse enlargement of the pancreas, with homogeneous echogenicity and absence of focal lesions. Computed tomography (CT) suggested mild acute pancreatitis (CT Severity Index:1) (Fig. 1). Dapsone was interrupted, along with NPO and fluid and electrolyte replacement. Gastrointestinal symptoms disappeared within 24 h. Five days after admission the biochemical parameters became normal (amylase 36 IU/L; lipase 73 IU/L). Although the outcome is generally good, internal organ complications, and deaths can occur with Dapsone treatment [4]. Frequently, adverse effects become evident 2–7 wk after the beginning of treatment [1–3, 5]. In our patient, the occurrence of repeated episodes of abdominal pain and vomiting and their improvement after interruption of Dapsone, the increased levels of pancreatic enzymes and the comprehensive exclusion of other possible causes of pancreatitis led us to suspect isolated acute pancreatitis induced by Dapsone. This was confirmed by the clinical and biochemical improvement observed after discontinuation. For ethical reasons, the patient was not re-exposed to the drug (Naranjo Scale Score: 8). To our knowledge this is the first report of isolated acute pancreatitis probably induced by Dapsone at pediatric age. This entity should be borne in mind, considering the increased use of this drug in recent years. A. Navarro-Mingorance :A. J. Castellanos-Alcarria : S. Ibanez-Mico :A. Cervantes-Pardo Department of Pediatrics, Universitary Hospital Virgen Arrixaca, Murcia, Spain