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CC BY-NC-ND 4.0 · Avicenna J Med 2017; 07(02): 67-70
DOI: 10.4103/ajm.AJM_124_16
CASE REPORT

Drug-induced hypersensitivity reaction: A case of simultaneous thyroiditis and fulminant type 1 diabetes

Michael Marchese
Division of Endocrinology, Phelps Medical Center, Sleepy Hollow, NY, USA
,
Matthew Leinung
Division of Endocrinology, Albany Medical Center, Albany, NY, USA
,
Hassan Shawa
Division of Endocrinology, Albany Medical Center, Albany, NY, USA
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
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Abstract

A 43-year-old incarcerated man with AIDS was hospitalized for 30 pounds weight loss and diffuse pruritic rash. Three months prior, he was started on dapsone for Pneumocystis jiroveci pneumonia prevention. Biochemical evaluation was remarkable for eosinophilia, thrombocytopenia, acute renal insufficiency, transaminitis, thyrotoxicosis, and significant hyperglycemia (450 mg/dl; nl, 65–99). His hemoglobin A1c level was 5.9% (nl, 4.1–5.6). Thyroid-stimulating immunoglobulin, glutamic acid decarboxylase, and islet cell autoantibodies were within the normal range. He was found to have acute interstitial nephritis based on renal biopsy. He was diagnosed with hypersensitivity reaction due to dapsone. The patient was managed with a tapering dose of corticosteroid, beta-blocker, and multiple daily injections of insulin. The symptoms and biochemical disturbances including thyrotoxicosis resolved within a few weeks. Insulin requirements decreased but diabetes did not resolve with hemoglobin A1c of 6.1% a year after hospitalization. To our knowledge, this is the first case of hypersensitivity reaction due to dapsone causing simultaneous fulminant type 1 diabetes and thyroiditis.

Keywords

Fulminant type 1 diabetes - hypersensitivity syndrome - thyroiditis - thyrotoxicosis


Publication History

Article published online:
09 August 2021

© 2017. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms: DRESS). Semin Cutan Med Surg 1996;15:250-7.
  • 2 Gennis MA, Vemuri R, Burns EA, Hill JV, Miller MA, Spielberg SP. Familial occurrence of hypersensitivity to phenytoin. Am J Med 1991;91:631-4.
  • 3 Descamps V, Valance A, Edlinger C, Fillet AM, Grossin M, Lebrun-Vignes B, et al. Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol 2001;137:301-4.
  • 4 Chen YC, Chiu HC, Chu CY. Drug reaction with eosinophilia and systemic symptoms: A retrospective study of 60 cases. Arch Dermatol 2010;146:1373-9.
  • 5 Dubois-Laforgue D, Moachon L, Laude H, Timsit J. Fulminant type 1 diabetes in the course of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Diabetes Care 2013;36:e68.
  • 6 Imagawa A, Hanafusa T. Fulminant type 1 diabetes – An important subtype in East Asia. Diabetes Metab Res Rev 2011;27:959-64.
  • 7 Onuma H, Tohyama M, Imagawa A, Hanafusa T, Kobayashi T, Kano Y, et al. High frequency of HLA B62 in fulminant type 1 diabetes with the drug-induced hypersensitivity syndrome. J Clin Endocrinol Metab 2012;97:E2277-81.
  • 8 Kano Y, Ishida T, Hirahara K, Shiohara T. Visceral involvements and long-term sequelae in drug-induced hypersensitivity syndrome. Med Clin North Am 2010;94:743-59, xi.
  • 9 Ichiche M, Kiesch N, De Bels D. DRESS syndrome associated with HHV-6 reactivation. Eur J Intern Med 2003;14:498-500.
  • 10 Shear NH, Spielberg SP. Anticonvulsant hypersensitivity syndrome.In vitro assessment of risk. J Clin Invest 1988;82:1826-32.
  • 11 Singer JZ, Wallace SL. The allopurinol hypersensitivity syndrome. Unnecessary morbidity and mortality. Arthritis Rheum 1986;29:82-7.
  • 12 Roujeau JC. Clinical heterogeneity of drug hypersensitivity. Toxicology 2005;209:123-9.
  • 13 Teo RY, Tay YK, Tan CH, Ng V, Oh DC. Presumed dapsone-induced drug hypersensitivity syndrome causing reversible hypersensitivity myocarditis and thyrotoxicosis. Ann Acad Med Singapore 2006;35:833-6.
  • 14 Imagawa A, Hanafusa T, Uchigata Y, Kanatsuka A, Kawasaki E, Kobayashi T, et al. Fulminant type 1 diabetes: A nationwide survey in Japan. Diabetes Care 2003;26:2345-52.
  • 15 Roxby A, Jain R. Dapsone interferes with hemoglobin A1c monitoring of diabetes in an HIV-infected patient. AIDS 2013;27:299-301.
  • 16 Shah AD, Fox RK, Rushakoff RJ. Falsely decreased HbA1c in a type 2 diabetic patient treated with dapsone. Endocr Pract 2014;20:e229-32.