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Methemoglobinemia associated with dapsone treatment in solid organ transplant recipients: a two-case report and
J S Plotkin1, J F Buell, M J Njoku
1Department of Anesthesiology, University of Maryland Medical Center, Baltimore 21201-1595, USA.
Abstract:
Dapsone, a sulfone antibiotic, has been increasingly used in solid-organ transplant recipients for the primary prevention of Pneumocystis carinii pneumonia, especially in patients with documented sulfa allergy. A known side effect of dapsone therapy, however, is methemoglobinemia, a condition leading to impaired tissue oxygen delivery. This report documents two cases of dapsone-induced methemoglobinemia in patients after solid organ transplantation with emphasis on the importance of clinical recognition and benefits of treatment. Further, the pathophysiology and causes of this condition are extensively reviewed.
Insights
Dapsone prevents Pneumocystis pneumonia in transplant patients but can cause methemoglobinemia, impairing oxygen delivery. Early recognition and treatment are crucial for managing this dapsone side effect.
Area of Science:
- Pharmacology
- Transplantation Medicine
- Hematology
Background:
- Dapsone is increasingly used for Pneumocystis pneumonia prophylaxis in solid-organ transplant recipients, particularly those with sulfa allergies.
- Methemoglobinemia is a known adverse effect of dapsone, characterized by reduced oxygen-carrying capacity of the blood.
- Solid organ transplantation involves complex immunosuppression and carries risks of opportunistic infections.
Observation:
- Two cases of dapsone-induced methemoglobinemia occurred in post-solid organ transplant patients.
- Patients presented with symptoms related to impaired tissue oxygen delivery.
- Clinical recognition of methemoglobinemia is essential for timely intervention.
Findings:
- Dapsone therapy was identified as the causative agent for methemoglobinemia in these transplant recipients.
- The pathophysiology and contributing factors of dapsone-induced methemoglobinemia were reviewed.
- Prompt treatment of methemoglobinemia led to improved patient outcomes.
Implications:
- Highlights the importance of monitoring for methemoglobinemia in transplant patients receiving dapsone.
- Underscores the need for clinician awareness regarding dapsone's potential adverse effects in immunocompromised populations.
- Suggests that early diagnosis and management of methemoglobinemia can mitigate serious complications in transplant recipients.