Methemoglobinemia induced by dapsone in a pediatric patient: case report.

Abstract

Methemoglobinemia is a rare condition and one of the differential diagnoses of cyanosis in the pediatric age group.(1) Clinical symptoms vary according to the levels of methemoglobin (MetHb) in the blood and may be nonspecific. The most common symptoms are central cyanosis, headache, fatigue, and respiratory depression.(2) Therefore, it is essential to recognize and treat the underlying cause. Methemoglobinemia is a syndrome of varied etiology, which may be congenital or acquired. The main acquired cause is a reaction to chemical agents.(1) One of the drugs most commonly associated with methemoglobinemia is dapsone, a sulfone antibiotic. Its traditional indication is for the treatment of dermatitis herpetiformis, but it is also used in the treatment of leprosy and in the prophylaxis of Pneumocystis jiroveci and toxoplasmosis.(2-5) Its use in oral form for the treatment of acne vulgaris is not well established.(6) This case report presents a patient treated at a pediatric emergency department and her outcome, aiming to discuss the diagnostic difficulties of methemoglobinemia in pediatrics and to draw the pediatric community’s attention to the potential severity of the diagnosis and the indiscriminate use of dapsone. This study was approved by the Ethics Committee of the Hospital Israelita Albert Einstein (HIAE) upon acceptance of the Free Consent Form and CAAE 65121122.6.0000.0071.