Leprosy Mailing List – October 31, 2016
Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB |
From: Ben Naafs, Munnesburen, the Netherlands
Dear Pieter,
I would like to refer to the letter by Dr. Nepal Nepali of October 30, 2016:
I understand that it is itchy. It does look urticarial with a vasculitis component. It could be a drug eruption or just a passing urticarial reaction due to anything. The risk is that it is the start of a dapsone syndrome which happens often in Nepali. This is a DRESS syndrome (Drug eruption with generalized symptoms). At least stop dapsone (and possibly also rifa) immediately and give steroids and antihistamines. Look for liver function and haemogram blood tests. There must be a Nepali protocol how to react in case of suspect dapsone syndrome!
If it is not dapsone, it can be any of the other drugs. I would continue the clofazimine. After the clinical picture (and lab. tests) becomes quite, introduce first the rifa, see what happens, then (under close supervision) the dapsone. In the meantime give antihistaminics.
Regards,
Dr Ben Naafs
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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