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Dapsone in Thrombocytopenia of the Antiphospholipid Antibody Syndrome
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TO THE EDITOR:
Kavanaugh [1] recently reported the beneficial effect of danazol on thrombocytopenia in a patient with the antiphospholipid antibody syndrome.
We describe a woman with thrombocytopenia associated with primary antiphospholipid syndrome who responded to dapsone therapy. Her medical history included two fetal losses. In December 1993, profound thrombocytopenia (platelet count, 10 × 109/L) was seen with another spontaneous abortion. Treatment with prednisone (80 mg daily) was started, and her platelet count transiently increased to 37 × 109/L. She was hospitalized in our unit in February 1994. Physical examination was unremarkable except for ecchymotic purpura. Prednisone (1 mg/kg body weight) was administered. Laboratory findings included a low platelet count (22 × 109/L), IgG platelet antibodies by direct immunofluorescence test, negative test results for antinuclear factors, and antibodies to native DNA and human immunodeficiency virus (HIV). IgG anticardiolipin antibodies were detected by enzyme-linked immunoassay (65 units; normal, <15 units). Dapsone (75 mg daily) was added to the regimen. One month later, her platelet count had increased to 108 × 109/L, and the dose of prednisone was tapered. The platelet count returned to within the normal range after 3 months of dapsone therapy. After 9 months of follow-up, the patient continues to receive low-dose prednisone (10 mg/d) and dapsone (75 mg/d) without side effects. Her platelet count remains within the normal range. The response of the platelet count to therapy is shown in Figure 1.
Dapsone treatment of autoimmune thrombocytopenic purpura has been reported to be effective, particularly in elderly patients [2] and in patients with HIV-related autoimmune thrombocytopenic purpura [3]. Godeau and colleagues [4] observed a response in 13 of 27 patients with no serious hematologic complications. Dapsone was also beneficial in a patient with thrombocytopenia that was associated with the primary antiphospholipid syndrome [5]. Although this drug affects phagocyte-mediated cytotoxicity [2], the mechanism of dapsone's effectiveness in autoimmune thrombocytopenic purpura remains unknown. Our experience suggests that dapsone may be a beneficial, safe, and inexpensive therapy in thrombocytopenia associated with the antiphospholipid antibody syndrome.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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