Dapsone
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Methaemoglobinaemia: case report A 35-year-old woman developed methaemoglobinaemia following treatment with dapsone for Pneumocystis carinii prophylaxis. The woman, who had a 16-year history of HIV infection, was admitted to a hospital with shortness of breath, generalised weakness and poor appetite since 2 weeks. A month prior to this presentation, she had been hospitalised for Candidal esophagitis and was discharged on dapsone 100mg daily [route not stated] for Pneumocystis carinii prophylaxis (due to sulfa allergy). Despite no radiographic evidence on chest X-ray/ CT scan, she was initially treated with prednisone, clindamycin and primaquine for presumed Pneumocystis carinii pneumonia. During the current course of admission, she showed low pulse oximetry readings despite oxygen therapy and developed perioral cyanosis. An arterial blood gas analysis showed normal partial pressure of oxygen with elevated methemoglobin levels of 24.9%. Diagnosis of dapsoneinduced methaemoglobinaemia was made. The woman’s treatment with dapsone was thus stopped, and primaquine and clindamycin were also discontinued. She received treatment with IV methylthioninium chloride [methylene blue] which led to improvement in her symptoms. Her pulse oximetry readings improved and methaemoglobin levels gradually decreased over 3 days. She was discharged on atovaquone and ascorbic acid with plans to initiate antiretroviral therapy as an outpatient. Author comment: "Dapsone is a common cause of methemoglobinemia which can cause impaired oxygen delivery to tissues resulting in cellular hypoxia. It should be suspected in the clinical setting of cyanosis, low pulse oximetry readings and normal partial pressure of oxygen on ABG and can be diagnosed by co-oximetry and elevated methemoglobin levels." Basyal B, et al. Dapsone induced methemoglobinemia: A tale of blue lips. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 467, No. 4, Apr 2018. Available from: URL: https://www.shmabstracts.com/abstract/dapsone-induced803432454 methemoglobinemia-a-tale-of-blue-lips/ [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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