Identifying the Cause of the "Saturation Gap": Two Cases of Dapsone-induced Methemoglobinemia

Intern Med. 2015;54(13):1639-41. doi: 10.2169/internalmedicine.54.3496. Epub 2015 Jul 1.

Abstract

Diaphenylsulfone (DDS: Dapsone) is used for Pneumocystis pneumonia (PCP) prophylaxis, and methemoglobinemia has rarely been reported as a side effect of DDS. We herein report two cases of DDS-related methemoglobinemia in an 81-year-old man with organizing pneumonia and an 84-year-old woman with eosinophilic pneumonia under treatment with prednisolone. Both patients initially received trimethoprim/sulfamethoxazole for PCP prophylaxis and were switched to DDS due to side effects and subsequently exhibited a clinically unexplainable decrease in SpO2. Methemoglobinemia was diagnosed based on the findings of arterial blood gas analyses. In both cases, the methemoglobinemia improved after discontinuing DDS.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / adverse effects*
  • Antibiotic Prophylaxis* / methods
  • Cryptogenic Organizing Pneumonia / drug therapy*
  • Dapsone / administration & dosage
  • Dapsone / adverse effects*
  • Female
  • Humans
  • Male
  • Methemoglobinemia / chemically induced*
  • Methemoglobinemia / drug therapy
  • Pneumonia, Pneumocystis / prevention & control*
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*

Substances

  • Anti-Infective Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Dapsone