Sulfone syndrome in a patient receiving steroids for pemphigus

A male patient who was being treated with oral prednisone for erosive mucocutaneous pemphigus lesions developed fever, jaundice, a rash, and anemia within 2 wk of starting dapsone therapy. These signs are typical of the sulfone syndrome, which is a potentially fatal condition due to dapsone hypersensitivity. The incidence of sulfone syndrome is increasing in frequency but has not previously been reported in pemphigus. This patient developed the syndrome early and while on oral steroids, which are sometimes used as a treatment for the sulfone syndrome, and without any evidence of a hypersensitivity reaction. Physicians should be aware of the potentially fatal sulfone syndrome in patients who are on dapsone therapy and who have abnormal liver tests, fever, and a rash.