KUTLU, Orkide Okmeydanı Eğitim ve Araştırma Hastanesi - İç Hastalıkları Bölümü, Turkey , KOCATÜRK, Emek Özgür Okmeydanı Eğitim ve Araştırma Hastanesi - Dermatoloji Bölümü, Turkey , CÜRE, Kübra Okmeydanı Eğitim ve Araştırma Hastanesi - Dermatoloji Bölümü, Turkey , DEMİRKESEN, Cuyan Acıbadem Üniversitesi - Tıp Fakültesi - Patoloji Anabilim Dalı, Turkey , ERUZUN, Hasan Okmeydanı Eğitim ve Araştırma Hastanesi - İç Hastalıkları Bölümü, Turkey , TÜKEK, Tufan İstanbul Üniversitesi - Tıp Fakültesi - İç hastalıkları Anabilim Dalı, Turkey

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

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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

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eosinophilic cellulitis , dapson , methemoglobinemia

Journal Of Istanbul Faculty Of Medicine

100