We describe a 22-year-old woman with cutaneous polyarteritis nodosa in
whom dapsone hypersensitivity syndrome (DHS) developed 5 weeks after
initiation of dapsone therapy. She had fever and cervical lymphadenopa
thy, and later a widespread erythematous eruption studded with pustule
s developed. She also had liver involvement with mixed hepatocellular
and cholestatic features. The patient was treated with prednisone 60 m
g daily. Once the patient's Liver function normalized, prednisone dosa
ge was reduced by 5 mg weekly. The clinical features and treatment of
DHS are reviewed. We encourage immediate discontinuation of the drug i
n a patient in whom a fever or flu-like illness develops, especially 4
or more weeks after the treatment is started. We also suggest routine
thyroid function testing 3 months after recovery because of the possi
ble risk of hypothyroidism.