Dapsone
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Hypoalbuminaemia: case report An approximately 66-year-old woman developed severe hypoalbuminaemia during treatment with dapsone for mucous membrane pemphigoid. The woman, at the age of 64 years, was referred to the current hospital for episodic widespread oral erosions evolving over the past 2 years. She did not have any known past drug and medical history. Based on the histologic pattern, clinical features, direct immunofluorescence and detection of serum anti-BP180 antibodies, a diagnosis of mucous membrane pemphigoid was made. Therefore, she was started on dapsone 75mg once daily [route not stated]. Eventually, complete remission with good clinical and biological tolerance was observed. Two years later, she presented for rapidly progressive dyspnoea associated with generalised oedema. A large right pleural effusion was noted on the chest radiograph. Also, thoracentesis was performed and more than half a liter of pleural liquid was removed. Biochemical analysis demonstrated a sterile yellow-citrine transudate. A plasma electrophoresis blood test revealed hypoalbuminaemia with hyponatremia and normal gammaglobulin level. Further studies did not show evidence for a digestive loss (diarrhoea or enteropathy) and proteinuria. Complete blood cell count did not show leucopenia or thrombopenia, which indicated portal hypertension. The woman was treated with unspecified diuretics for her dyspnoea without any improvement. A second thoracentesis and ascites puncture were performed, which removed 2.5L of pleural fluid and 3L of ascites, respectively. In view of absence of definite cause of hypoalbuminaemia, dapsone was suspected and her dapsone treatment was discontinued. During the month after discontinuation of dapsone, she lost 13kg weight and her albumin level was found to be normal and remained stable up to 8 months of follow-up. Based on presenting symptoms and investigational findings, she was diagnosed with dapsone-induced severe hypoalbuminaemia. Flament J, et al. Severe dapsone-induced hypoalbuminemia in a case of mucous membrane pemphigoid. JAAD Case Reports 6: 1098-1100, No. 10, Oct 2020. Available from: 803506936 URL: http://doi.org/10.1016/j.jdcr.2020.08.018
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Reactions 10 Oct 2020 No. 1825
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