Singapore - A 22-year-old serviceman on an oversees training exercise in Brunei, received 100 mg dapsone and 12.5 mg pyrimethamine (Maloprim®) weekly as antimalarial chemoprophylaxis.

Two weeks later, he developed fever which was resolved by taking paracetamol but was followed by sudden onset of pruritus on both hands. Pruritic papular rash appeared on hands and feet and progressed to the trunk. Fever returned with chills, left cervical and right inguinal lymphadenopathy and hepatosplenomegaly. Maloprim® was discontinued. On admission to hospital he was afebrile and had bilateral periorbital swelling. The arms, legs and trunk were covered by an erythematous papular rash and petechiae on the feet. The skin had begun to exfoliate. After four days' treatment with oral prednisolone and hydroxyzine he recovered.

Reference: Singapore Adverse Drug Reaction News, Volume 2 (1), March 2000.