Aortic dissection type A, common carotid artery occlusion, and stroke after dapsone for 20 years

Long-term use of dapsone, a sulfone with anti-inflammatory and immunosuppressive properties, has not been previously reported in association with aortic dissection type A. The patient is a 61-year-old male who suffered an acute type-A aortic dissection at rest at the age of 56. Due to the involvement of the right common carotid artery in the dissection, he also suffered an ischemic stroke with left hemiparesis. His past medical history was positive for continuous use of dapsone (100 mg/d) for 20 years for a bullous, pruritic eczema. Besides dapsone, smoking was the only risk factor for aortic dissection. He underwent aortic valve and aortic replacement and achieved a modified Ranking score of 2 after administration of phenprocumon, bisoprolol, atorvastatin, and sertraline and intensive rehabilitation. Since quinolones are associated with aortic dissection, it was assumed that dapsone was also involved in the pathophysiology of aortic dissection. This case demonstrates that long-term use of dapsone may contribute to vascular pathology that ultimately leads to aortic dissection. Unless necessary, dapsone should not be given for years.