Dapsone-induced haemolytic anaemia, hepatitis and agranulocytosis in a leprosy patient with normal glucose-6-phosphate-dehydrogenase activity

Summary A 21 year old boy with borderline lepromatous leprosy and normalglucose-6-phosphate-dehydrogenase activity developed haemolytic anaemia, hepa-titis and agranulocytosis following 19 weeks of multi-bacillary multi-drug therapy.With early administration of antibiotics and G-CSF our patient recovered withoutresidual complications. All patients taking dapsone should be warned to discontinuethe drug immediately in the event of fever, chills and sore throat occurring withinthe treatment period until further investigations are performed. IntroductionDapsone is used as a primary drug for leprosy. The adverse effects of dapsone includehaemolysis, methaemoglobinaemia and hepatitis. Agranulocytosis is rare; this severe andunpredictable idiosyncratic reaction has been reported to occur in 0·2–0·4% of patientstreated with dapsone. 1–5 Agranulocytosis is a fatal complication, which is characterised by a decrease in peripheralneutrophil count to less than 0·5 £ 10 9 cells/L, where other cell populations remain relativelynormal.Case ReportA 21 year old boy presented with six hypopigmented, anaesthetic macules on the back of thetrunk of 1 year’s duration. Borderline lepromatous leprosy was diagnosed and was started on