Unusual cause of persistent dyspnea in a patient with nephrotic syndrome: dapsone-induced methemoglobinemia

Mannemuddhu, Sai Sudha; Ali, Rozina; Kadhem, Salam; Ruchi, Rupam

doi:10.1007/s13730-020-00565-8

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…It is unclear if nephrotic syndrome increases the risk of methemoglobinemia due to dapsone. Two additional cases of dapsone-induced methemoglobinemia in patients with nephrotic syndrome have been recently reported [6,8]. We want to raise awareness of this possible association so that patients can be monitored closely for this side effect.…”

Section: Discussionmentioning

confidence: 99%

“…Acquired methemoglobinemia due to medications is the most common cause of methemoglobinemia; dapsone is the most common agent as found by a retrospective study [2]. Other medications associated with acquired methemoglobinemia include sulfonamides, chloroquine, benzocaine, lidocaine, nitroprusside, rasburicase, and rifampin [1,2,6]. Dapsone is a sulfone antibiotic with anti-inflammatory properties mostly used for Pneumocystis jiroveci pneumonia prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Dapsone is a sulfone antibiotic with anti-inflammatory properties mostly used for Pneumocystis jiroveci pneumonia prophylaxis. It is also used to treat dermatitis herpetiformis, leprosy, toxoplasmosis, ulcerative colitis, as well as immune thrombocytopenic purpura [4,6]. Additionally, patients with anemia are at higher risk of developing methemoglobinemia [6] while blood transfusions or exchange can decrease levels [5].…”

Section: Discussionmentioning

confidence: 99%

“…Ascorbic acid should be started on patients with suspicion of glucose-6-phosphate dehydrogenase deficiency or if methylene blue is otherwise contraindicated or unavailable [1]. Patients usually respond to treatment with methylene blue within 60 minutes; treatment can be repeated if needed [1,6]. In our case, an additional dose of methylene blue was given to the patient for persistent symptoms thought to be related to the extended half-life of dapsone metabolites (i.e., hydroxylated amine metabolites), which are potent oxidants that cause dapsone's adverse effects including methemoglobinemia and hemolytic anemia [4].…”

Section: Discussionmentioning

confidence: 99%

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Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease

Gonzalez¹,

Pargament²

2022

Cureus

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Our case report represents the need to maintain vigilance for methemoglobinemia risk in patients without classic symptoms, specifically, in patients that develop shortness of breath after starting prophylaxis for Pneumocystis jiroveci pneumonia, mostly with dapsone.A case report of a 42-year-old male with minimal change disease nephrotic syndrome required Pneumocystis jiroveci pneumonia prophylaxis due to high-dose systemic steroids. The patient was started on dapsone due to side effects and the availability of alternative medications. Since starting therapy, the patient developed progressive dyspnea upon exertion for two weeks with intermittent hypoxia. The patient tested negative for glucose-6-phosphate dehydrogenase deficiency prior to starting dapsone. He was also on therapeutic enoxaparin due to a hypercoagulability state from nephrotic syndrome. The patient presented with hypoxia and dyspnea upon exertion, however, speaking in complete sentences and with no cyanosis or overt findings of hypervolemia. The patient remained hypoxemic despite supplemental oxygen. An arterial blood gas was performed and showed methemoglobin levels of 10.6 percent. He was treated with methylene blue with the resolution of methemoglobinemia and hypoxemia after a second dose. Trimethoprim-sulfamethoxazole was started for Pneumocystis jiroveci pneumonia prophylaxis. He was safely discharged home.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease

Gonzalez¹,

Pargament²

2022

Cureus

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“…Additionally, there are other cases of drug‐induced dyspnoea which are related to the perturbed Hb. For instance, a patient with nephrotic syndrome presented with shortness of breath after administration of dapsone which was considered as the cause of methaemoglobinaemia by oxidating Fe 2+ 39 . Therefore, it is speculated that Hb would be a critical target strongly associated with the drug‐induced dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

Network pharmacology‐based dissection of the underlying mechanisms of dyspnoea induced by zedoary turmeric oil

Yang

Wang

et al. 2022

Basic Clin Pharma Tox

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Zedoary turmeric oil (ZTO) has been widely used in clinic. However, the unpleasant induced dyspnoea inevitably impedes its clinical application. Thus, it is urgent to elucidate the mechanism underlying the ZTO‐induced dyspnoea. In this study, network pharmacology was firstly performed to search the clue of ZTO‐induced dyspnoea. The key target genes of ZTO‐induced dyspnoea were analysed using GO enrichment analysis and KEGG pathway analysis. GO analysis suggested that haem binding could be a key molecular function involved in ZTO‐induced dyspnoea. Hence, the haemoglobin (Hb) was focused for its oxygen‐carrying capacity with haem as its critical component binding to the oxygen. Ultraviolet–visible absorption spectrum indicated that the ZTO injection (ZTOI) perturbed the Soret band of Hb, suggesting an interaction between ZTO and Hb. GC–MS analysis revealed that β‐elemene, germacrone, curdione and furanodiene were main components of ZTOI. Molecular docking was used to illustrate the high affinity between representative sesquiterpenes and Hb, which was finally confirmed by surface plasmon resonance, suggesting their potential roles in dyspnoea by ZTO. Following a network pharmacology‐driven strategy, our study revealed an intervened Hb‐based mechanism underlying the ZTO‐induced dyspnoea, providing a reference for elucidating mechanism underlying adverse drug reactions of herbal medicines in clinic.

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Overview and Current Advances in Dapsone Hypersensitivity Syndrome

Wang,

Zeng,

et al. 2023

Curr Allergy Asthma Rep

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Unusual cause of persistent dyspnea in a patient with nephrotic syndrome: dapsone-induced methemoglobinemia

Cited by 5 publications

References 26 publications

Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease

Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease

Network pharmacology‐based dissection of the underlying mechanisms of dyspnoea induced by zedoary turmeric oil

Overview and Current Advances in Dapsone Hypersensitivity Syndrome

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