A Case of Cyanosis: Dapsone Induced Methemoglobinemia and Coexisting Pulmonary Embolism

Amjad, Waseem; Sandhu, Rana; Aung, Shwe

doi:10.1097/mjt.0000000000000578

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2023

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Cited by 3 publications

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“…Clinically the patient was doing well, but he was hypoxic (saturation 89 % in room air) without symptoms. A pulmonary artery thrombus was diagnosed with computed tomography (CT) and anticoagulant medication was prescribed [6] , [7] . The patient risk factors for pulmonary embolism were: smoking, admission to the intensive care, immobilization and a central venous catheter line.…”

Section: Case Reportmentioning

confidence: 99%

Treatment of a life-threatening dapsone intoxication

Veerman,

van Gelder,

Sneijder

et al. 2023

Toxicology Reports

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Section: Case Reportmentioning

confidence: 99%

Treatment of a life-threatening dapsone intoxication

Veerman,

van Gelder,

Sneijder

et al. 2023

Toxicology Reports

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Dapsone

2019

Reactions Weekly

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Dapsone Hydroxylamine, an Active Metabolite of Dapsone, Can Promote the Procoagulant Activity of Red Blood Cells and Thrombosis

Bian

Kim

et al. 2019

Toxicological Sciences

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Dapsone hydroxylamine (DDS-NHOH), N-hydroxylated metabolite of a sulfonamide antibiotic, dapsone, is responsible for various adverse effects of dapsone that include methemoglobinemia, hemolytic anemia, and thrombosis. However, the mechanism underlying DDS-NHOH-induced thrombosis remains unclear. Here, we demonstrated that DDS-NHOH, but not dapsone, could increase prothrombotic risks through inducing the procoagulant activity of red blood cells (RBCs). In freshly isolated human RBCs in vitro, sub-hemolytic concentrations of DDS-NHOH (10–50 μM) increased phosphatidylserine (PS) exposure and augmented the formation of PS-bearing microvesicles (MV). Reactive oxygen species (ROS) generation and the subsequent dysregulation of enzymes maintaining membrane phospholipid asymmetry were found to induce the procoagulant activity of DDS-NHOH. Dapsone hydroxylamine also accelerated thrombin generation and enhanced RBC self-aggregation and adherence of RBCs to endothelial cells in vitro. Most importantly, both the single dose of 50 or 100 mg/kg (i.p.) DDS-NHOH and repeated doses of 10 mg/kg per day (i.p.) for 4 days increased thrombus formation in rats (six rats per dose) in vivo, substantiating a potential prothrombotic risk of DDS-NHOH. Collectively, these results demonstrated the central role of RBC procoagulant activity induced by DDS-NHOH in the thrombotic risk of dapsone.

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A Case of Cyanosis: Dapsone Induced Methemoglobinemia and Coexisting Pulmonary Embolism

Cited by 3 publications

References 4 publications

Treatment of a life-threatening dapsone intoxication

Treatment of a life-threatening dapsone intoxication

Dapsone

Dapsone Hydroxylamine, an Active Metabolite of Dapsone, Can Promote the Procoagulant Activity of Red Blood Cells and Thrombosis

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