Ascorbic Acid as an Effective Alternative for Treatment of Dapsone Poisoning in a Child: A Case Report

Abstract

Dapsone (DDS-Diamino diphenyl sulfone), a sulfonamide derivative acts by inhibiting PABA incorporation into folic acid. It is commonly used in treating skin diseases. Accidental poisoning in children is uncommon. It results in methaemoglobinemia by causing oxidative stress. Principle of treatment relies on treating methemoglobinemia by using reducing agents like methylene blue or ascorbic acid. Due to the long half-life, dapsone provides a continuing oxidative stress that can cause a recurrence of clinically significant methaemoglobinaemia and hence takes long to treat. Ascorbic acid is effective in treating methemoglobinemia associated with dapsone poisoning as demonstrated in this case report of a four and half year old child's accidental ingestion of dapsone tablets and presenting with cyanosis. The child was managed successfully with ascorbic acid and supportive treatment.

Effective role of ascorbic acid as an alternative treatment of methemoglobinemia: A case report

“…Methemoglobinemia in the present case was developed after therapeutic dose of dapsone. Dapsone is commonly used in treatment of leprosy but its use has expanded into the treatment of many skin diseases [4]. Methemoglobinemia associated with dapsone commonly as an adverse effect of the drug like patients use dapsone for pseudomonas jiroveci pneumonia prophylaxis in stem cell transplantation [5,6].…”

“…Dapsone induces a continuing oxidative stress due to the long half-life, thus serial measurements of methemoglobin levels should be done [4]. Initial management of acquired methemoglobinemia inculdes identification and discontinuation of the offending agent and increasing tissue oxygenation by administration of reducing agent as MB and ascorbic acid [1].…”

Accidental Ingestion of Dapsone in Children - A Case Report Experienced in Government Tertiary Care Hospital

“…In less severe cases, ascorbic acid 200-500 mg can be given intravenously as was used in our case [23]. In a case reported by Agrawal., et al, Ascorbic acid alone was used successfully to treat Methemoglobinemia due to Dapsone consumption [7].…”

“…Evidence of hemolysis characterized by drop in hemoglobin, hematocrit and increase in reticulocyte count (3.6%) was observed on day four of admission for which PRBC transfusion was given. Next two days, we have Dapsone, a sulfone is a structural analog of paraaminobenzoic acid (PABA) and a competitive inhibitor of dihydropteroate synthase in the folate pathway [7]. The indications for dapsone are varied and include the management of Pneumocystis carinii pneumonia (PCP) in immunosuppressed patients, dermatitis vulgaris, herpetiformis, psoriasis, pemphigus, acne lupus erythematosus profundus, brown recluse spider bites, pyoderma gangrenous [7] prophylaxis and treatment of falciparum malaria maduromycosis, panniculitis due to alpha-1 antitrypsin deficiency [1,4,9].…”

“…Because of its use in various conditions, its toxicity is commonly seen in adults [4]. However, dapsone intoxication in children is usually accidental and has been considered invariably fatal [6,7]. Methemoglobinemia is the major life-threatening situation associated with poisoning of DDS [8].…”