Teo Rachael Y L, Tay Yong-Kwang, Tan Chong-Hiok, Ng Victor, Oh Daniel C T
Division of Dermatology, Changi General Hospital, Singapore.
Ann Acad Med Singap. 2006 Nov;35(11):833-6.
A 22-year-old Malay soldier developed dapsone hypersensitivity syndrome 12 weeks after taking maloprim (dapsone 100 mg/pyrimethamine 12.5 mg) for anti-malarial prophylaxis.
He presented with fever, rash, lymphadenopathy and multiple-organ involvement including serositis, hepatitis and thyroiditis. Subsequently, he developed congestive heart failure with a reduction in ejection fraction on echocardiogram, and serum cardiac enzyme elevation consistent with a hypersensitivity myocarditis.
Maloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor.
He has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission.
In summary, we report a case of dapsone hypersensitivity syndrome with classical symptoms of fever, rash and multi-organ involvement including a rare manifestation of myocarditis. To our knowledge, this is the first case of dapsone-related hypersensitivity myocarditis not diagnosed in a post-mortem setting. As maloprim is widely used for malaria prophylaxis, clinicians need to be aware of this unusual but potentially serious association.
一名22岁的马来士兵在服用防疟药马洛普明（氨苯砜100毫克/乙胺嘧啶12.5毫克）进行疟疾预防12周后，出现了氨苯砜超敏综合征。
他出现发热、皮疹、淋巴结病以及多器官受累，包括浆膜炎、肝炎和甲状腺炎。随后，他发展为充血性心力衰竭，超声心动图显示射血分数降低，血清心肌酶升高，符合超敏性心肌炎。
停用马洛普明，并给予类固醇、利尿剂和血管紧张素转换酶抑制剂治疗。
入院10个月后，他完全康复，甲状腺炎消退，射血分数恢复正常。
总之，我们报告了一例氨苯砜超敏综合征，伴有发热、皮疹和多器官受累的典型症状，包括罕见的心肌炎表现。据我们所知，这是第一例在尸检之外诊断出的与氨苯砜相关的超敏性心肌炎病例。由于马洛普明广泛用于疟疾预防，临床医生需要意识到这种不寻常但可能严重的关联。
