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Abstract: TH-PO525

Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials


  • Rovira-Gonzalez, Manuel Jose, WellSpan York Hospital Department of Internal Medicine, York, Pennsylvania, United States
  • Pargament, Robert, WellSpan York Hospital Department of Internal Medicine, York, Pennsylvania, United States

Methemoglobinemia has been most commonly associated with medication and anesthetic use, dapsone and benzocaine being the most common agents. Methemoglobinemia leads to tissue hypoxia by creating ferric (Fe3+) hemes where oxygen is unable to bind, increasing the affinity of oxygen to hemoglobin, and therefore, reducing oxygen delivery to tissue. In the case of dapsone, it is the potent hydroxylated amine oxidant metabolites that causes dapsone’s adverse effects including methemoglobinemia and hemolytic anemia. Clinical presentation of methemoglobinemia results in refractory hypoxemia, cyanosis, and dark-colored arterial blood.

Case Description

A case report about a 42-year-old male with minimal change disease required pneumocystis jiroveci pneumonia prophylaxis due to high dose steroids. Patient was started on dapsone due to side effects and availability from alternative medications. Patient was tested negative for glucose-6-phosphate dehydrogenase deficiency prior to starting dapsone. Since starting therapy, patient developed progressive dyspnea upon exertion for two weeks with intermittent hypoxia. He was also on therapeutic enoxaparin due to hypercoagulability state from nephrotic syndrome. Patient presented with hypoxia and dyspnea upon exertion, however, speaking in complete sentences and with no cyanosis or overt findings of hypervolemia. Patient remained hypoxemic despite supplemental oxygen. An arterial blood gas was performed and showed methemoglobin levels of 10.6 percent. Patient was treated with methylene blue with resolution of methemoglobinemia and hypoxemia after second dose. Trimethoprim-sulfamethoxazole was started for pneumocystis jiroveci pneumonia prophylaxis. He was safely discharged home.


Patients can present with methemoglobinemia without classical symptoms; however, desaturations, a saturation gap, and shortness of breath are other signs and symptoms to be aware of in the absence of cyanosis. It is unclear if nephrotic syndrome increases risk of methemoglobinemia due to dapsone. We want to increase awareness of reported cases and further association is needed to understand the pathophysiology in dapsone-induced methemoglobinemia in patients with nephrotic syndrome.