Dapsone
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Methaemoglobinaemia: case report A 70-year-old man developed methaemoglobinaemia during treatment with dapsone for prophylaxis of pneumocystis pneumonia. The man had a history of chronic obstructive pulmonary disease, pulmonary embolism and lung adenocarcinoma. Prior to the presentation, he had undergone left lower lobectomy and received treatment with chemo-radiation. During chemo-radiation, he had developed oesophageal strictures, oesophageal perforations, tracheal-oesophageal fistula and mucous plugging due to excess secretions. Concomitantly, he had been receiving unspecified steroids for dermatomyositis. Due to the chronic use of steroids, he was receiving dapsone [route and dosage not stated] as a prophylactic treatment against pneumocystis pneumonia. At the current presentation, he presented to the hospital due to dehydration, worsened shortness of breath and progressive dysphagia. Upon admission, he was found to be hypoxic. Hence, the man received supplemental oxygen therapy, which showed improvement in oxygenation. Initially, his symptoms were attributed to compromised lung and new bronchial stenosis at the left main-stem. He was placed on Venturi mask 40%. His arterial blood gas tests revealed the following: methaemoglobin level 16.2%, arterial oxygen level 81mm Hg and oxygen haemoglobin saturation 78%. Hence, he was diagnosed with methaemoglobinaemia [duration of treatment to reaction onset not stated]. Therefore, he started receiving 100% oxygen therapy, and dapsone was stopped. Subsequently, his methaemoglobin levels improved, and resolved completely on day 5. Hotchandani N, et al. Natural course of dapsone induced methemoglobinemia with conservative management. American Journal of Respiratory and Critical Care Medicine 199: (plus poster), No. 9, May 2019. Available from: URL: https://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3193 [abstract] 803447239
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Reactions 18 Jan 2020 No. 1787
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