Dapsone Hypersensitivity Syndrome-related Lung Injury without Eosinophilia in the Bronchoalveolar Lavage Fluid

Yuhei Kinehara; Takashi Kijima; Koji Inoue; Haruhiko Hirata; Yoshiko Takeuchi; Kiyoharu Fukushima; Yoshitomo Hayama; Masayoshi Higashiguchi; Osamu Morimura; Kotaro Miyake; Toshiyuki Minami; Izumi Nagatomo; Yoshito Takeda; Hiroshi Kida; Atsushi Kumanogoh

doi:10.2169/internalmedicine.54.3406

CASE REPORTS

Dapsone Hypersensitivity Syndrome-related Lung Injury without Eosinophilia in the Bronchoalveolar Lavage Fluid

Yuhei Kinehara, Takashi Kijima, Koji Inoue, Haruhiko Hirata, Yoshiko Takeuchi, Kiyoharu Fukushima, Yoshitomo Hayama, Masayoshi Higashiguchi, Osamu Morimura, Kotaro Miyake, Toshiyuki Minami, Izumi Nagatomo, Yoshito Takeda, Hiroshi Kida, Atsushi Kumanogoh

Author information

Yuhei Kinehara
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Takashi Kijima
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Koji Inoue
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Haruhiko Hirata
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Yoshiko Takeuchi
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Kiyoharu Fukushima
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Yoshitomo Hayama
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Masayoshi Higashiguchi
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Osamu Morimura
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Kotaro Miyake
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Toshiyuki Minami
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Izumi Nagatomo
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Yoshito Takeda
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Hiroshi Kida
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Atsushi Kumanogoh
Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan
Department of Immunopathology, Immunology Frontier Research Center, Osaka University, Japan

Keywords: dapsone hypersensitivity syndrome, human herpes virus-6, drug-induced hypersensitivity syndrome, bronchoalveolar lavage fluid

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 7 Pages 827-831

DOI https://doi.org/10.2169/internalmedicine.54.3406

Details

Abstract

A 73-year-old man was admitted in respiratory failure that had subacutely progressed after five weeks of dapsone treatment for a skin rash. He also presented with fever, systemic erythroderma and liver dysfunction. Chest computed tomography showed diffuse reticular shadows with ground-glass opacity and bilateral mediastinal lymphadenopathy. Lymphocytes, but not eosinophils, were increased in the bronchoalveolar lavage fluid. Moreover, reactivation of human herpes virus-6 was confirmed on a paired serum test. Finally, we diagnosed the patient with dapsone hypersensitivity syndrome (DHS), a rare adverse event of this drug. Lung injury unaccompanied by eosinophilia in the bronchoalveolar lavage fluid is even more rare as a DHS-related lung manifestation.

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