Dapsone
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Methaemoglobinaemia: case reports In a case series, two women aged 51 years and 71 years were described, who developed methaemoglobinaemia while receiving dapsone as Pneumocystis pneumonia prophylaxis after solid organ transplantation [dosage and route not stated]. Case 1: The woman aged 51 years, underwent deceased donor renal transplant due to lupus nephritis. After the procedure, she started receiving Pneumocystis pneumonia prophylaxis therapy with cotrimoxazole [trimethoprim/sulfamethoxazole], which was later changed to dapsone due to worsening hyperkalaemia. Her postoperative course was complicated by delayed graft function requiring re-hospitalisation after 1 week with dyspnoea on exertion. At the time of re-admission, her vital signs were normal except for oxygen saturation of 91%. The oxygen saturation later decreased to 88%. Venous thromboembolism exams showed negative result, and further tests showed normal results for chest radiography and the level of cardiac enzymes. Arterial blood gas analysis showed elevated levels of methaemoglobin at 12%. Development of dapsone associated methaemoglobinaemia was considered. Her dapsone therapy was stopped, and atovaquone was started. She also received two daily doses of methylene blue. Subsequent improvement was noted in her condition as the methaemoglobin level decreased to 7.7%, her oxygen saturation increased to 90% and all her symptoms resolved. Case 2: The woman aged 71 years, underwent a living related renal transplant due to immunoglobulin-A nephropathy. As her medical history was significant for sulfa allergy, she was started on dapsone for Pneumocystis pneumonia prophylaxis. However, during the hospital stay, she became hypoxic with decreased oxygen saturation of 90–92% and elevated methaemoglobin level of 12.8%. Development of dapsone associated methaemoglobinaemia was considered. Consequently, her dapsone therapy was changed to atovaquone. She also received one dose of methylene blue. Subsequent improvement was noted in her condition as the methaemoglobin level decreased to 2.7%, her oxygen saturation increased to 92.7% and all her symptoms resolved. Torabi J, et al. Dapsone-Induced Methemoglobinemia in Two Renal Transplant Recipients. Progress in Transplantation (Aliso Viejo, Calif.) 29: 289-290, No. 3, Sep 2019. 803498080 Available from: URL: http://doi.org/10.1177/1526924819855365
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Reactions 29 Aug 2020 No. 1819
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