Identifying the Cause of the "Saturation Gap": Two Cases of Dapsone-induced Methemoglobinemia

Kenjiro Furuta; Satoshi Ikeo; Takuya Takaiwa; Satoshi Ikeda; Akihiro Nishiyama; Toshihide Yokoyama; Akihiro Ito; Fumiaki Tokioka; Maki Tanaka; Hiroshige Yoshioka; Hiromasa Tachibana; Machiko Arita; Toru Hashimoto; Tadashi Ishida

doi:10.2169/internalmedicine.54.3496

CASE REPORTS

Identifying the Cause of the "Saturation Gap": Two Cases of Dapsone-induced Methemoglobinemia

Kenjiro Furuta, Satoshi Ikeo, Takuya Takaiwa, Satoshi Ikeda, Akihiro Nishiyama, Toshihide Yokoyama, Akihiro Ito, Fumiaki Tokioka, Maki Tanaka, Hiroshige Yoshioka, Hiromasa Tachibana, Machiko Arita, Toru Hashimoto, Tadashi Ishida

Author information

Kenjiro Furuta
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Satoshi Ikeo
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Takuya Takaiwa
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Satoshi Ikeda
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Akihiro Nishiyama
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Toshihide Yokoyama
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Akihiro Ito
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Fumiaki Tokioka
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Maki Tanaka
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Hiroshige Yoshioka
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Hiromasa Tachibana
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Machiko Arita
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Toru Hashimoto
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan
Tadashi Ishida
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan

Keywords: methemoglobinemia, dapsone, diaphenylsulfone, saturation gap

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 13 Pages 1639-1641

DOI https://doi.org/10.2169/internalmedicine.54.3496

Details

Abstract

Diaphenylsulfone (DDS: Dapsone) is used for Pneumocystis pneumonia (PCP) prophylaxis, and methemoglobinemia has rarely been reported as a side effect of DDS. We herein report two cases of DDS-related methemoglobinemia in an 81-year-old man with organizing pneumonia and an 84-year-old woman with eosinophilic pneumonia under treatment with prednisolone. Both patients initially received trimethoprim/sulfamethoxazole for PCP prophylaxis and were switched to DDS due to side effects and subsequently exhibited a clinically unexplainable decrease in SpO₂. Methemoglobinemia was diagnosed based on the findings of arterial blood gas analyses. In both cases, the methemoglobinemia improved after discontinuing DDS.

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