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Case Report


DOI :https://doi.org/10.18017/iuitfd.01209   IUP :https://doi.org/10.18017/iuitfd.01209    Full Text (PDF)

DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT

Orkide Kutlu, Emek Özgür Kocatürk, Kübra Cüre, Cuyan Demirkesen, Hasan Eruzun, Tufan Tükek

Wells syndrome (eosinophilic cellulitis), is a rare inflammatory dermatosis characterized by persistent/recurrent erythematous papules, nodules, blisters with various morphology and severity. Etiology is not clear, although insect bites, hematological disorders, malignancies, infections and various drugs have been reported. It has been shown that clinical disease activity is correlated with IL5 level/eosinophils in peripheral blood and bone marrow. Histopathological examination shows edema and eosinophil-rich infiltrate of dermis in acute period, “flame figures” via degranulation of eosinophils surrounding collagen bands in subacute period, phagocytic histiocytes and giant cells around the flame figures in remission period; vasculitis is not present. Herein we report a case with widespread urticarial eruptions after antibiotic use for acute pharyngitis diagnosed as Wells Syndrome and developed methemoglobinemia after dapsone treatment.

Case: A 24 year old woman, was admitted to our outpatient clinic with common urticarial lesions after treatment with amoxicillin clavulanic acid. Lesions were annular, erythematous, indurated plaques with changing diameters.. A relapse was occured after oral methylprednisolone/cetirizine/topical mometasone treatment. After treatment resistance with hydroxychloroquine for 6 weeks, dapsone was started. On the 5th day of 2x100 mg dapsone treatment severe headache, dizziness, palpitations, fatigue, was considered methemoglobinemia: Dapsone induced methemoglobinemia was shown with 5.10 % methemoglobin level and followed up with supportive treatment. Conclusıon: The basis for the treatment of Wells syndrome is corticosteroids; while antihistamines, hidroksikloroquin, griseofulvin, dapsone and immunosupressants (cyclosporine, azathioprine, tacrolimus) can be used. Patients using dapsone should be monitored closely for methemoglobinemia and treated effectively as needed.

Keywords: eosinophilic cellulitis, dapson, methemoglobinemia
DOI :https://doi.org/10.18017/iuitfd.01209   IUP :https://doi.org/10.18017/iuitfd.01209    Full Text (PDF)

WELLS SENDROMLU HASTADA DAPSONA BAĞLI METHEMOGLOBİNEMİ GELİŞİMİ: OLGU SUNUMU

Orkide Kutlu, Emek Özgür Kocatürk, Kübra Cüre, Cuyan Demirkesen, Hasan Eruzun, Tufan Tükek

Amaç: Wells sendromu (eozinofilik sellülit), prodromal yanma veya kaşınmayla başlayan eritematöz papül, nodül, büller şeklinde, çeşitli morfolojilerde ve ciddiyette aylar, yıllar boyu persistan veya rekürren erüpsiyonlarla seyreden nadir bir inflamatuvar dermatozdur. Etiyoloji net olmamakla birlikte böcek ısırıkları, hematolojik bozukluklar, maligniteler, enfeksiyonlar ve çeşitli ilaçlarla ilgili bildirimler mevcuttur. Hastalığın klinik aktivitesiyle periferik kanda IL5, kan ve kemik iliğinde eozinofil seviyeleri arasında korelasyon olduğu gösterilmiştir. Histopatolojik olarak akut dönemde dermiste ödem ve eozinofillerden zengin infiltrat, subakut dönemde kollagen bantları çevreleyen eozinofillerin degranülasyonuyla ‘’alev figürleri’’ ve sonrasında alev figürleri etrafında fagositik histiyositler ve dev hücreleri görülür; vaskülit bulguları yoktur. Burada akut farenjit sebebi ile antibiyotik kullanımı sonrası vücudunda yaygın ürtikeryal döküntüleri başlayan hastada Wells Sendromu tanısı koyduğumuzu ve dapson tedavisi sonrası methemoglobinemi gelişimini bildirmek istedik.

Olgu: 24 yaşında kadın, amoksisilin klavulanik asit tedavisi sonrası tüm vücutta yaygın ürtikeryal lezyonlar ile polikliniğimize başvurdu. Lezyonlar anüler görünümde, eritemli, merkezi soluk, endüre plaklar şeklinde olup oral metilprednizolon/setirizin/topikal mometazon tedavisiyle düzeldikten sonra nüks gelişmiş; 6 hafta süre ile kullanılan hidroksiklorokine direnç sebebi ile dapson başlanmıştı. 2x100 mg dapson tedavisinin 5. gününde şiddetli baş ağrısı, baş dönmesi, çarpıntı, hâlsizlik, huzursuzluk sonrası methemoglobin: % 5.10 saptanan hastada dapsona bağlı methemoglobinemi düşünüldü ve olgu destek tedavi ile takip edildi.

Sonuç: Wells sendromunda tedavinin temelini kortikosteroidler oluşturur; antihistaminikler, hidroksiklorokin, griseofulvin, dapson ve gereğinde immunsupresanlar (siklosporin, azotioprin, takrolimus) kullanılabilir. Dapson kullanan hastalar methemoglobinemi açısından yakından takip edilmeli ve gereğinde etkili bir şekilde tedavi edilmelidir. 

Keywords: Eozinofilik sellülit, dapson, methemoglobinemi

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References

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APA

Kutlu, O., Kocatürk, E.Ö., Cüre, K., Demirkesen, C., Eruzun, H., & Tükek, T. (0001). DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT. Journal of Istanbul Faculty of Medicine, 79(2), 97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209


AMA

Kutlu O, Kocatürk E Ö, Cüre K, Demirkesen C, Eruzun H, Tükek T. DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT. Journal of Istanbul Faculty of Medicine. 0001;79(2):97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209


ABNT

Kutlu, O.; Kocatürk, E.Ö.; Cüre, K.; Demirkesen, C.; Eruzun, H.; Tükek, T. DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT. Journal of Istanbul Faculty of Medicine, [Publisher Location], v. 79, n. 2, p. 97-100, 0001.


Chicago: Author-Date Style

Kutlu, Orkide, and Emek Özgür Kocatürk and Kübra Cüre and Cuyan Demirkesen and Hasan Eruzun and Tufan Tükek. 0001. “DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT.” Journal of Istanbul Faculty of Medicine 79, no. 2: 97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209


Chicago: Humanities Style

Kutlu, Orkide, and Emek Özgür Kocatürk and Kübra Cüre and Cuyan Demirkesen and Hasan Eruzun and Tufan Tükek. “DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT.” Journal of Istanbul Faculty of Medicine 79, no. 2 (Oct. 2024): 97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209


Harvard: Australian Style

Kutlu, O & Kocatürk, EÖ & Cüre, K & Demirkesen, C & Eruzun, H & Tükek, T 0001, 'DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT', Journal of Istanbul Faculty of Medicine, vol. 79, no. 2, pp. 97-100, viewed 13 Oct. 2024, https://doi.org/https://doi.org/10.18017/iuitfd.01209


Harvard: Author-Date Style

Kutlu, O. and Kocatürk, E.Ö. and Cüre, K. and Demirkesen, C. and Eruzun, H. and Tükek, T. (0001) ‘DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT’, Journal of Istanbul Faculty of Medicine, 79(2), pp. 97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209 (13 Oct. 2024).


MLA

Kutlu, Orkide, and Emek Özgür Kocatürk and Kübra Cüre and Cuyan Demirkesen and Hasan Eruzun and Tufan Tükek. “DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT.” Journal of Istanbul Faculty of Medicine, vol. 79, no. 2, 0001, pp. 97-100. [Database Container], https://doi.org/https://doi.org/10.18017/iuitfd.01209


Vancouver

Kutlu O, Kocatürk EÖ, Cüre K, Demirkesen C, Eruzun H, Tükek T. DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT. Journal of Istanbul Faculty of Medicine [Internet]. 13 Oct. 2024 [cited 13 Oct. 2024];79(2):97-100. Available from: https://doi.org/https://doi.org/10.18017/iuitfd.01209 doi: https://doi.org/10.18017/iuitfd.01209


ISNAD

Kutlu, Orkide - Kocatürk, EmekÖzgür - Cüre, Kübra - Demirkesen, Cuyan - Eruzun, Hasan - Tükek, Tufan. “DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH WELLS SYNDROME: A CASE REPORT”. Journal of Istanbul Faculty of Medicine 79/2 (Oct. 2024): 97-100. https://doi.org/https://doi.org/10.18017/iuitfd.01209



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