Keywords
Cyanosis
Partial Pressure of Oxygen (PO2)
Partial Pressure of Carbon Dioxide (PCO2)
Metheglobin (MetHb)
Daposone
Categories
How to Cite
Abstract
Introduction: Methemoglobinemia (MetHb) is the elevation of the blood level of hemoglobin with ferric ion (+3)). Hemoglobin is unable to dissociate from oxygen without being able to deliver it to tissues. The clinical symptoms and plasma metahemoglobin levels guide us in the diagnosis. It can originate congenitally or acquired, characterized mainly by hypoxemia. It can originate congenitally or acquired, characterized mainly by hypoxemia. Case Report: A 22-year-old male with a history of treated pulmonary coccidioidomycosis and pulmonary sequelae from COVID-19. He is currently being treated with dapsone for dermatosis caused by Nocardia asteroides. Three weeks prior to admission, he began experiencing dyspnea with small to moderate exertion, as well as fatigue, weakness, and decreased oxygen saturation to 72%, which was associated with distal cyanosis. This was the reason for his visit to the emergency department. Upon admission, he was found to have refractory hypoxemia despite supplemental oxygen. Laboratory results showed normocytic hypochromic anemia and mixed acidosis on blood gas analysis, with suspected methemoglobinemia due to dapsone use. His methemoglobin levels were 26.6%. Treatment with methylene blue and ascorbic acid was started, resulting in a decrease in methemoglobin levels and clinical improvement Discussion: Methemoglobinemia is a rare entity that may go unnoticed depending on its origin. Having adequate diagnostic tools, the discarding of differential diagnoses and a good history are key to a good diagnostic approach
References
Bradberry S. Methaemoglobinaemia. Medicine [Internet]. 2007 Oct 1;35(10):552–3. Available from: https://doi.org/10.1016/j.mpmed.2007.07.008
Oliveira FR, Pessoa MC, Albuquerque RFV, Schalcher TR, Monteiro MC. Clinical applications and methemoglobinemia induced by Dapsone. Journal of the Brazilian Chemical Society [Internet]. 2014 Jan 1; Available from: https://doi.org/10.5935/0103-5053.20140168
Ivan GV, Giorgio FK, Anapaula HV, Iván GV, Giorgio FK, Anapaula HV. Metahemoglobinemia severa secundaria a sobredosis de dapsona, reporte de caso [Internet]. Available from: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid =S2448-89092017000500285
Fernendez-Merjildo D, Pierola JZ, Orbegoso OH, Garcia MM. Exanguinotransfusión como tratamiento de metahemoglobinemia secundaria a dapsona. Reporte de caso. Revista Medica Herediana [Internet]. 2017 Jan 10;27(4):243. Available from: https://doi.org/10.20453/rmh.v27i4.2994
Ludlow JT, Wilkerson RG, Nappe TM. Methemoglobinemia [Internet]. StatPearls - NCBI Bookshelf. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537317/
Intraoperative detection of methemoglobinemia in a patient given benzocaine spray to relieve discomfort from a nasogastric tube: a case report [Internet]. PubMed. 2008. Available from: https://pubmed.ncbi.nlm.nih.gov/18478813/
Kabir H, Lakshmanan R, Gopinath S, Bhonagiri D. Dapsone-induced methemoglobinemia-A case report. Clinical Case Reports [Internet]. 2021 May 1;9(5). Available from: https://doi.org/10.1002/ccr3.4054
Mahmood N, Khan MU, Haq IUL, Jelani FA, Tariq A. A case of DAPSONE INDUCED METHEMOGLOBINEMIA. Journal of Pharmaceutical Policy and Practice [Internet]. 2019 Jun 20;12(1). Available from: https://doi.org/10.1186/s40545-019-0185-y
Dapsone Induced methaemoglobinemia: early intraoperative: Indian Journal of Anaesthesia [Internet]. LWW. Available from: https://journals.lww.com/ijaweb/fulltext/2008/52020/dapsone _induced_methaemoglobinemia__early.16.aspx
Vieira JLF, Riveira JGB, De Nazaré Silva Martins A, Da Silva JP, Salgado CG. Methemoglobinemia and dapsone levels in patients with leprosy. The Brazilian Journal of Infectious Diseases [Internet]. 2010 Jun 1;14(3):319–21. Available from: https://doi.org/10.1590/s1413-86702010000300022
Iolascon A, Bianchi P, Andolfo I, Russo R, Barcellini W, Fermo E, et al. Recommendations for diagnosis and treatment of methemoglobinemia. American Journal of Hematology [Internet]. 2021 Sep 1;96(12):1666–78. Available from: https://doi.org/10.1002/ajh.26340
Iliev YT, Zagorov MY, Grudeva-Popova JG. Acute Poisoning with Dapsone and Olanzapine: Severe Methemoglobinemia and Coma with a Favourable Outcome. Folia Medica [Internet]. 2015 Jun 1;57(2):122–6. Available from: https://doi.org/10.1515/folmed-2015-0030
Carrazza MZN, Carrazza FR, Oga S. Clinical and laboratory parameters in dapsone acute intoxication. Revista De Saude Pública [Internet]. 2000 Aug 1;34(4):396–401. Available from: https://doi.org/10.1590/s0034-89102000000400013
De Moraes NV, Bergamaschi MM, De Lourdes Pires Bianchi M, Bragheto JB, Malfara WR, Queiroz RHC. L-arginine, a nitric oxide precursor, reduces dapsone-induced methemoglobinemia in rats. Brazilian Journal of Pharmaceutical Sciences [Internet]. 2012 Mar 1;48(1):87–94. Available from: https://doi.org/10.1590/s1984-82502012000100010
Cefalu JN, Joshi TV, Spalitta MJ, Kadi CJ, Diaz JH, Eskander JP, et al. Methemoglobinemia in the operating room and intensive care unit: early recognition, pathophysiology, and management. Advances in Therapy [Internet]. 2020 Mar 19;37(5):1714–23. Available from: https://doi.org/10.1007/s12325-020-01282-5
Kim YJ, Sohn CH, Ryoo SM, Ahn S, Seo DW, Lee YS, et al. Difference of the clinical course and outcome between dapsone-induced methemoglobinemia and other toxic-agent-induced methemoglobinemia. Clinical Toxicology [Internet]. 2016 May 12;54(7):581–4. Available from: https://doi.org/10.1080/15563650.2016.1178759
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Octavio Sanchez-Escudero, Aaron Gastelum-Reina, Juan Islas-Serrano, Rosa E Sosa-Camas, Pamela Elena Baez-Islas