Using Dapsone in ITP

Q: Am 27 yrs old male having known ITP. My platelet counts started lowering when I was 22 yrs old. After doing bone marrow they confirmed it’s ITP and was put on prednisolone for the first time. After 3 or 4 episodes my hematologists asked me to take dapsone. I used dapsone for about 8 months and stopped due to lymphadenopathy. Thereafter, I used to take prednisolone whenever this episode occurs. Recently I came to know that I can take both prednisolone and dapsone at the same time. So this time I started this about 1 month ago. Now I have a tender swelling which is firm on either side near to lower rib. I doubt it is a node or something. There is no change in urine color or any difficulty in urination. I experience cough and sinusitis almost all the time. Professionally, I am a dentist.
-By Dr. Azhar

Reply:

This doesn’t sound like a lymph node. Lymph nodes are anatomically not placed there. We have the mediastinal group of lymph nodes to drain most of the part of the chest.

The tender swellings may have a musculoskeletal origin. You need to get a direct physical exam to investigate what it is.

ITP episodes are traditionally treated with corticosteroids.

Dapsone is a new experimental drug, used in ITP and similar conditions these days.

You need to be watchful about its side effects, since you are using it for a long period.

Side Effects of Dapsone

• Hematological complications like aplastic anemia, leukopenia, agranulocytosis, eosinophilia and macrocytic anemia.  It has been observed that a low dose of vitamin E may be protective against dapsone-induced hematological complications.
• Back, leg, or stomach pains
• Bluish fingernails, lips, due to vascular complications. Skin rashes may be seen.
• Dapsone may also cause an increase in overall eosinophil count. The patient may observe difficulty in breathing
• Fever and loss of appetite
• General fatigue
• The drug is hepatotoxic, so liver function tests need to be carried out at regular intervals.

Take Care,

Buddy M.D.