Permanent retinal damage following massive dapsone overdose.

Kenner, David; Holt, Kelsey; Agnello, R; Chester, G. H.

doi:10.1136/bjo.64.10.741

Cited by 35 publications

(9 citation statements)

References 19 publications

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“…Recovery might occur; however, this may take many months to several years. Tragic cases of patients who had ingested dapsone with suicidal intention confirm the ability of the drug to damage the peripheral nervous system, including the optic nerve resulting in blindness [ 77 , 91 ]. In any case, if any signs of neuropathy show, therapy with dapsone should be immediately stopped (Figs.…”

Section: Adverse Effects Of Dapsonementioning

confidence: 99%

Dapsone in dermatology and beyond

2013

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Dapsone (4,4′-diaminodiphenylsulfone) is an aniline derivative belonging to the group of synthetic sulfones. In 1937 against the background of sulfonamide era the microbial activity of dapsone has been discovered. Shortly thereafter, the use of dapsone to treat non-pathogen-caused diseases revealed alternate antiinflammatory mechanisms that initially were elucidated by inflammatory animal models. Thus, dapsone clearly has dual functions of both: antimicrobial/antiprotozoal effects and anti-inflammatory features similarly to non-steroidal anti-inflammatory drugs. The latter capabilities primarily were used in treating chronic inflammatory disorders. Dapsone has been investigated predominantly by in vitro methods aiming to get more insights into the effect of dapsone to inflammatory effector cells, cytokines, and/or mediators, such as cellular toxic oxygen metabolism, myoloperoxidase-/halogenid system, adhesion molecules, chemotaxis, membrane-associated phospholipids, prostaglandins, leukotrienes, interleukin-8, tumor necrosis factor α, lymphocyte functions, and tumor growth. Moreover, attention has been paid to mechanisms by which dapsone mediates effects in more complex settings like impact of lifespan, stroke, glioblastoma, or as anticonvulsive agent. Additionally, there are some dermatological investigations in human being using dapsone and its metabolites (e.g., leukotriene B4-induced chemotaxis, ultraviolet-induced erythema). It could be established that dapsone metabolites by their own have anti-inflammatory properties. Pharmacology and mechanisms of action are determining factors for clinical use of dapsone chiefly in neutrophilic and/or eosinophilic dermatoses and in chronic disorders outside the field of dermatology. The steroid-sparing effect of dapsone is useful for numerous clinical entities. Future avenues of investigations will provide more information on this fascinating and essential agent.

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Section: Adverse Effects Of Dapsonementioning

confidence: 99%

Dapsone in dermatology and beyond

2013

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“…Permanent retinal necrosis has been reported following massive dapsone overdose 13 . Our patient recovered without any residual morbidity.…”

Section: Discussionmentioning

confidence: 99%

Acute Dapsone Overdose: The Effects of Continuous Veno-Venous Haemofiltration on the Elimination of Dapsone

Masurkar

Edstein

Gorton

et al. 2011

Anaesth Intensive Care

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A 15-year-old girl presented after intentional ingestion of dapsone (7.2 g) and small quantities of azathioprine, methotrexate and prednisolone. The resulting methaemoglobinaemia and lactic acidosis persisted despite treatment with methylene blue, multiple-dose activated charcoal and ascorbic acid. Continuous veno-venous haemofiltration for 75 hours was used to treat the dapsone overdose. The patient's serum dapsone concentrations were measured during and after continuous veno-venous haemofiltration. The rate of elimination of dapsone was over three times higher during, compared to after, continuous veno-venous haemofiltration. Continuous renal replacement therapy successfully reduced toxic dapsone concentrations in this patient with a good outcome.

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“…NIRS, therefore, has the advantages of offering a noninvasive, continuous, real-time measurement of brain oxygenation without any known adverse effects. NIRS has been used to monitor cerebral oxygenation during cardiopulmonary bypass and carotid endarterectomy [12,13]. Here we report its use to monitor changes in cerebral oxygenation which occur during hypothermic circulatory arrest and then after the introduction of retrograde cerebral perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Blurred vision has been reported and may occur after a period of normal vision. This necessitates careful ophthalmic assessment as the retinal damage may become permanent [13]. Steroids may have a role in this situation.…”

Section: Symptoms and Signsmentioning

confidence: 99%

Near‐infrared spectroscopy changes during hypothermic circulatory arrest with retrograde cerebral perfusion

Rigg

Clutton-Brock

1997

Anaesthesia

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SummaryWe report on the changes in cerebral near-infrared spectroscopy during grafting of a thoraco-abdominal aneurysm. A 58-year-old man presented with a complex dissecting aortic aneurysm. Repair of the aneurysm was performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Cerebral near-infrared spectroscopy monitoring revealed a reduction in the values recorded for total haemoglobin, oxygenated haemoglobin and cytochrome aa3 along with an increase in deoxygenated haemoglobin during circulatory arrest. When retrograde cerebral perfusion was commenced the signals representing total haemoglobin, oxygenated haemoglobin and cytochrome aa3 were all restored to near baseline values. Deoxygenated haemoglobin, however, remained elevated. These changes support the hypothesis that some cerebral perfusion occurs during retrograde cerebral perfusion. Keywords ... Correspondence to: Dr T. H. Clutton-BrockNear-infrared spectroscopy (NIRS) is a technique that is used for measuring the absorption of near-infrared light by chromophores (i.e. haem-containing species). Total haemoglobin, its constituent oxygenated and deoxygenated forms and cytochrome aa3, which is the terminal enzyme in the mitochondrial respiratory chain, all absorb infrared light and can be quantified by NIRS [1][2][3]. The attraction of NIRS is in its potential to yield noninvasive information on both organ blood flow and cellular activity. We report on the NIRS changes which occurred when monitoring cerebral activity during hypothermic circulatory arrest with retrograde cerebral perfusion. Case historyA 58-year-old man was admitted for emergency graft repair of an ascending and descending thoraco-abdominal aneurysm. He presented with acute severe chest pain and had recently had a mild right-sided stroke. Chest X-ray revealed a wide mediastinum and subsequent computerised axial tomography and echocardiography confirmed a complex aortic dissection originating from just above the aortic valve and extending to just above the renal arteries. There was minimal evidence of aortic regurgitation and left ventricular function was reported to be good.The patient was premedicated with temazepam, ranitidine and metaclopromide and anaesthesia was induced with fentanyl and etomidate followed by pancuronium. The patient's trachea was intubated and anaesthesia was maintained with intravenous infusions of propofol (5 356ᮊ 1997 Blackwell Science Ltd of total haemoglobin (THb), oxygenated haemoglobin (O 2 Hb), deoxygenated haemoglobin (HHb) and cytochrome aa3 (Cyt) activity. The data from the monitor were collected via the serial port of a notebook personal computer using Critikon data logger software.After a left posterolateral thoracotomy the patient was established on cardiopulmonary bypass (CPB) with bicaval venous lines and a right femoral arterial line (Fig. 1a). Interposition grafting of the ascending aorta, including the arch of the aorta, was performed using hypothermic circulatory arrest and retrograde cerebral perfusion. To achieve this, t...

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Permanent retinal damage following massive dapsone overdose.

Cited by 35 publications

References 19 publications

Dapsone in dermatology and beyond

Dapsone in dermatology and beyond

Acute Dapsone Overdose: The Effects of Continuous Veno-Venous Haemofiltration on the Elimination of Dapsone

Near‐infrared spectroscopy changes during hypothermic circulatory arrest with retrograde cerebral perfusion

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