Acute dapsone poisoning in a 3-year-old child: Case report with review of literature

Abstract

Dapsone (DDS-diamino diphenyl sulphone) is a sulfone antibiotic being used for a variety of clinical conditions. Poisoning in children by DDS is rarely reported. Poisoning in acute cases will be frequently unrecognized due to relative lack of severe signs and symptoms. Methemoglobinemia is the major life-threatening situation associated with poisoning of DDS. Hence, any delay for medical attention can lead to increased rate of mortality. In this case, we describe acute DDS poisoning in a 3-year-old child and the successful management using intravenous methylene blue.

Ascorbic Acid as an Effective Alternative for Treatment of Dapsone Poisoning in a Child: A Case Report

“…Accidental dapsone poisoning is a pediatric emergency in young preschool children [6]. Dapsone, a sulfone, is a structural analog of paraaminobenzoic acid (PABA) and a competitive inhibitor of dihydropteroate synthase in the folate pathway.…”

Dermatitis herpetiformis

“…The possible side effects of dapsone are well known. Some of the known side effects are the hematological ones such as methemoglobinemia [99]. Methemoglobinemia causes insufficient oxygen to the tissues and manifests by cyanosis, grayish-blue color, weakness, nausea, tachycardia, and abdominal pain [54].…”

Accidental Ingestion of Dapsone in Children - A Case Report Experienced in Government Tertiary Care Hospital

“…Next two days, we have Dapsone, a sulfone is a structural analog of paraaminobenzoic acid (PABA) and a competitive inhibitor of dihydropteroate synthase in the folate pathway [7]. The indications for dapsone are varied and include the management of Pneumocystis carinii pneumonia (PCP) in immunosuppressed patients, dermatitis vulgaris, herpetiformis, psoriasis, pemphigus, acne lupus erythematosus profundus, brown recluse spider bites, pyoderma gangrenous [7] prophylaxis and treatment of falciparum malaria maduromycosis, panniculitis due to alpha-1 antitrypsin deficiency [1,4,9]. Accidental dapsone poisoning in children is uncommon [8].…”

“…Dapsone hydroxylamine enters red cells leading to methemoglobin formation. The most frequent reaction that occur with higher doses of Dapsone toxicity is hemolytic anemia and methemoglobinemia [9][10][11][12]. The N-hydroxylation of dapsone to its hydroxylamine metabolite is in part responsible for methemoglobinemia in both therapeutic use and over dose.…”

“…Methemoglobinemia is the major life-threatening situation associated with poisoning of DDS [8]. In initial stages of acute poisoning, there will not be any major manifestations and hence there may be delay in seeking medical attention [9]. Here we report a case of accidental severe dapsone poisoning with methemoglobinemia with sinus arrhythmia.…”