Raizman M B, Fay A M, Weiss J S
New England Eye Center, Tufts University School of Medicine, Boston, MA 02111.
Ophthalmology. 1994 Nov;101(11):1805-7. doi: 10.1016/s0161-6420(94)31098-0.
Dapsone is used widely in treating ocular cicatricial pemphigoid, leprosy, and dermatologic disorders. Hemolysis is a well-known complication of dapsone therapy. Rarely, neutropenia or agranulocytosis may occur, resulting in up to a 50% mortality rate. To the authors' knowledge, agranulocytosis has not been reported in patients treated with dapsone for ocular cicatricial pemphigoid.
The authors report two cases of dapsone-induced neutropenia with bone marrow suppression in patients with ocular cicatricial pemphigoid.
Neutropenia was detected on routine laboratory examination 8 and 10 weeks after initiating dapsone therapy. Bone marrow biopsy showed acellular or hypocellular marrow. Leukocyte count returned to baseline value after cessation of dapsone.
Patients with ocular cicatricial pemphigoid who were treated with dapsone are at increased risk for agranulocytosis. Dapsone-induced neutropenia may not be a dose-dependent phenomenon. The authors indicate that there is a need for routine monitoring of leukocyte counts, especially 8 to 10 weeks after initiating therapy. Signs or symptoms of infection require immediate investigation.
氨苯砜广泛用于治疗瘢痕性类天疱疮、麻风病和皮肤病。溶血是氨苯砜治疗众所周知的并发症。罕见的是，可能会发生中性粒细胞减少或粒细胞缺乏症，导致高达50%的死亡率。据作者所知，在使用氨苯砜治疗瘢痕性类天疱疮的患者中尚未报告粒细胞缺乏症。
作者报告了2例瘢痕性类天疱疮患者发生氨苯砜诱导的中性粒细胞减少伴骨髓抑制的病例。
在开始氨苯砜治疗后8周和10周的常规实验室检查中检测到中性粒细胞减少。骨髓活检显示无细胞或细胞减少的骨髓。停用氨苯砜后白细胞计数恢复到基线值。
接受氨苯砜治疗的瘢痕性类天疱疮患者发生粒细胞缺乏症的风险增加。氨苯砜诱导的中性粒细胞减少可能不是剂量依赖性现象。作者指出，需要常规监测白细胞计数，尤其是在开始治疗后8至10周。感染的体征或症状需要立即进行检查。
