title: Dapsone induced methemoglobinemia in a patient with glioblastoma.
abstract: Primary brain tumor patients have multiple risk factors for Pneumocystis jiroveci and may require prophylaxis with TMP-SMZ or dapsone. Although dapsone is generally safe and efficacious, we present a case of a patient diagnosed with a brain stem glioblastoma who developed methemoglobinemia and haemolytic anemia after presenting with worsening confusion and cardiopulmonary system dysfunction. This case highlights one of the potentially severe complications associated with dapsone therapy. Although this illustrates an unusual toxicity of dapsone, a high index of suspicion should be given to high-risk patients due to ethnic heritage, anemia, or advanced age. Furthermore, given the toxicities of TMP-SMZ and dapsone, further work is needed to determine the threshold CD4(+) count at which empiric prophylaxis should be initiated.
authors.affiliation: Department of Neuro-Oncology, The University of Texas - M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Julie G
authors.initials: JG
authors.lastname: Walker
authors.forename: Tapan
authors.initials: T
authors.lastname: Kadia
authors.forename: Latrondria
authors.initials: L
authors.lastname: Brown
authors.forename: Harinder S
authors.initials: HS
authors.lastname: Juneja
authors.forename: John F
authors.initials: JF
authors.lastname: de Groot
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects*; D020295:Brain Stem Neoplasms / Q000150:complications* / Q000188:drug therapy; D003622:Dapsone / Q000009:adverse effects*; D005909:Glioblastoma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000150:complications*; D008875:Middle Aged
chemical_list: D000890:Anti-Infective Agents; D003622:Dapsone