Acute fatal DDS poisoning. (Report of 4 cases)

Acute dapsone poisoning is rare and such cases are either accidental or suicidal. Though accidental DDS poisoning are reported in children, the same is fairly uncommon in adults. Only 2 such cases are reported in India literature. We here report 4 cases of fatal sucidial DDS poisoning in adults resulting death in 3 cases. The reported acute symptoms include nausea, vomiting, hyperexcitability followed by depression, Carpopedal spasm or convulsions. The most marked signs are dyspnoea and cyanosis. The symptoms are due to methaemoglobinaemia, and or sulphaemoglobinaemia. Normally dapsone induces red cell haemolysis and even with small therapeutic doses of 25-100 mg per day, and in toxic doses reduces the oxygen carrying capacity of blood and damages the red cells making them more vulnerable for haemolysis. The peculiarity of the presentation in this series are manifestation of severe haemorrhagic episode in one case and progressive jaundice in another besides cyanosis. None of the cases had carpopedal spasm or convulsion. Out of four cases three died inspite of intensive care, intravenous vitamin C, exchange transfusion (2 cases) and other supportive measures. Intravenous methylene blue could not be used in these cases due to non-availability.