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Published on: April 16, 2019
Dapsone induced methemoglobinemia in a patient with glioblastoma
Julie G Walker1, Tapan Kadia, Latrondria Brown
1Department of Neuro-Oncology, The University of Texas - M. D. Anderson Cancer Center, Houston, TX, USA.
Abstract:
Primary brain tumor patients have multiple risk factors for Pneumocystis jiroveci and may require prophylaxis with TMP-SMZ or dapsone. Although dapsone is generally safe and efficacious, we present a case of a patient diagnosed with a brain stem glioblastoma who developed methemoglobinemia and haemolytic anemia after presenting with worsening confusion and cardiopulmonary system dysfunction. This case highlights one of the potentially severe complications associated with dapsone therapy. Although this illustrates an unusual toxicity of dapsone, a high index of suspicion should be given to high-risk patients due to ethnic heritage, anemia, or advanced age. Furthermore, given the toxicities of TMP-SMZ and dapsone, further work is needed to determine the threshold CD4(+) count at which empiric prophylaxis should be initiated.
Insights
Primary brain tumor patients may need Pneumocystis jiroveci prophylaxis. Dapsone, while generally safe, can cause severe methemoglobinemia and hemolytic anemia in high-risk individuals.
Area of Science:
- Neuro-oncology
- Infectious Diseases
- Pharmacology
Background:
- Patients with primary brain tumors face increased risk of Pneumocystis jiroveci infections.
- Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) or dapsone is often considered for these patients.
- Dapsone is generally well-tolerated but carries potential risks.
Observation:
- A patient with brain stem glioblastoma developed severe confusion and cardiopulmonary dysfunction.
- The patient subsequently experienced methemoglobinemia and hemolytic anemia.
- These adverse events occurred following dapsone therapy.
Findings:
- This case illustrates a rare but serious complication of dapsone treatment.
- Risk factors for dapsone toxicity include ethnic heritage, anemia, and advanced age.
- Methemoglobinemia and hemolytic anemia are potential adverse effects.
Implications:
- A high index of suspicion for dapsone toxicity is crucial in at-risk patients.
- Further research is needed to establish optimal CD4(+) count thresholds for initiating prophylaxis.
- Balancing the benefits and risks of Pneumocystis jiroveci prophylaxis in immunocompromised patients requires careful consideration.
