Dapsone/ferrous oxalate
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Dapsone/ferrous oxalate Iron overload: 2 case reports Two men developed hepatic iron overload during treatment with dapsone/ferrous oxalate [Disulone]. A 51-year-old man, who had been receiving oral dapsone/ ferrous oxalate 150 and 200 mg/day for approximately 17 years for a vascular purpura with histological signs of neutrophilic dermatosis, showed signs of moderate melanoderma on clinical examination. Laboratory analysis revealed a serum ferritin level of 1168 µg/L (normal 30–350), transferrin saturation of 55% (25–45), serum iron level of 30 µmol/L (12.5–25), and chronic haemolysis (haptoglobin level of 0.08 g/L and total bilirubin level of 21 µmol/L). A liver biopsy showed hepatocellular and sinusoidal iron overload with no fibrosis. Because it was not possible to stop dapsone/ ferrous oxalate, he underwent phlebotomy once every 15 days and then once every 2 months. Approximately 6 years after phlebotomy was started, his ferritin and serum iron levels were normal (91 mmol/L and 14.7 µmol/L, respectively). A 52-year-old man, who had been receiving dapsone/ ferrous oxalate 200 mg/day for 25 years for dermatitis herpetiformis associated with coeliac disease, showed signs of mild melanoderma and splenomegaly on clinical examination. Laboratory analysis revealed a serum iron level of 28.4 µmol/L, a ferritin level of 451 µg/L, a transferrin saturation of 75%, and chronic haemolysis (indicated by macrocytosis with a mean corpuscular volume of 115µ3 and reticulocytosis of 120 000/mm3). His ALT level was 63 IU/L. A liver biopsy revealed iron overload in his parenchyma with no fibrosis and a hepatic iron level of > 150 µmol/g (normal < 36 µmol/g). He continued to receive dapsone/ferrous oxalate. He did not tolerate a nongluten diet. About a year later, he was lost to follow-up. Darrieux L, et al. Disulone and hepatosiderosis. Annales de Dermatologie et de Venereologie 133: 683-685, No. 8-9, Part 1, Aug-Sep 2006 [French; summarised 801053431 from a translation] - France
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Reactions 2 Dec 2006 No. 1130
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