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Dapsone-Induced Granulomatous Cholestatic Hepatitis Unmasked by Steroid Taper: A Case Report
Journal article   Open access   Peer reviewed

Dapsone-Induced Granulomatous Cholestatic Hepatitis Unmasked by Steroid Taper: A Case Report

Shahana Prakash, Matthew Gosse and Tomohiro Tanaka
Case reports in gastroenterology, Vol.17(1), pp.362-366
12/11/2023
DOI: 10.1159/000534818
PMCID: PMC10712981
PMID: 38090636
url
https://doi.org/10.1159/000534818View
Published (Version of record) Open Access

Abstract

Dapsone is known to cause drug-induced liver injury (DILI) but can rarely induce the formation of hepatic granulomas. We describe a patient with jaundice who demonstrated granulomas on liver biopsy in response to dapsone. Her symptoms were only evident once steroids, used to also treat her pyoderma gangrenosum, had been tapered. In this case, a 67-year-old female was hospitalized due to 1 day of jaundice. She had started dapsone and prednisone concurrently 7 weeks ago to treat her pyoderma gangrenosum. Steroids were discontinued 4 days prior to symptoms. Her laboratories were notable for newly elevated alkaline phosphatase (756 U/L), aspartate transaminase (199 U/L), alanine transaminase (273 U/L), and total bilirubin (12.6 mg/dL). Dapsone was held due to suspicion for DILI. A liver biopsy was performed and disclosed non-necrotizing hepatic granulomas. After infectious and autoimmune causes were excluded, dapsone was determined to be the cause of her hepatic granulomas. Her bilirubin and liver enzymes steadily normalized over the next 4 weeks following discontinuation of dapsone. Thus, dapsone-related liver injury may present following a steroid taper if dapsone and steroids had been initially started together. Hepatic granulomas, though rare, can be seen when dapsone causes DILI.
 Dapsone Granuloma Case report Drug-induced liver injury

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