[Dapsone (4,4'-diaminodiphenyl sulfone) resolved severe leukocytopenia and thrombocytopenia in a patient with systemic lupus erythematosus].

A 47 year old woman was presented in June, 1994 with a ten years history of systemic lupus erythematosus. Since six months before first visit to our hospital, she had experienced general malaise, myalgia and persistent low grade fever. Among this period, titers of anti DNA antibody in her blood were gradually increased. She had been treated with the prednisolone which was step-wisely increased up to 15 mg/day, but her symptoms had been worsened. On admission, physical examination showed low grade fever and erythema on her both hands. Investigations showed her white blood cell count 1400/microliter, platelet 90000/microliter, positive test result for ANA, anti DNA antibody and anti Sm antibody, low serum concentrations of complements, and persistent proteinuria. She was treated with 60 mg/day of oral prednisolone. Though her symptoms and immunological abnormalities were gradually improved, her platelet count and white blood cell count were gradually decreased to 50000/microliter and 1400/microliter in August, respectively. Platelet associated IgG was increased (102.9 ng/10(7) cells). In spite of the various trials of treatment, such as plasmapheresis, high-dose intravenous gammaglobulin, and cyclophosphamide, the white blood cell and platelet number could not be raised. Finally, the administration of 75 mg/day of dapsone brought a significant rise in both blood cell counts. Thus being certainly effective against leukocytopenia and thrombocytopenia, dapsone should be considered an one of the beneficial therapeutic procedures for refractory autoimmune leukocytopenia and thrombocytopenia in SLE patients.