title: Dapsone induced hemolysis in a patient with ANCA associated glomerulonephritis and normal G6PD level and implications for clinical practice: case report and review of the literature.
abstract: Dapsone is a commonly used second line drug for prophylaxis of pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients. Oxidant hemolysis, caused by dapsone's metabolite hydroxylamine, is a common side effect, and screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency is recommended before the drug is started in order to prevent potential hemolytic reactions. We report a case of dapsone induced hemolytic anemia in a patient with ANCA associated glomerulonephritis and normal G6PD level. Her anemia improved after cessation of therapy with dapsone. We review the literature of dapsone induced hemolysis in patients who have normal G6PD level and discuss potential pathways leading to hemolytic anemia and its implications for clinical practice.
authors: Division of Nephrology, Johns Hopkins University, 301 Mason Lord Drive, Baltimore, MD 21224 USA.
authors: Scott M
authors: SM
authors: Lee
authors: Division of Nephrology, Johns Hopkins University, 301 Mason Lord Drive, Baltimore, MD 21224 USA.
authors: Duvuru
authors: D
authors: Geetha
references: Clin Infect Dis. 1998 Jul;27(1):191-204
references: 9675476
references: Arthritis Rheum. 1997 Dec;40(12):2187-98
references: 9416856
references: Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):795-9
references: 7881673
references: Blood Rev. 2007 Sep;21(5):267-83
references: 17611006
references: Arthritis Rheum. 2000 May;43(5):1021-32
references: 10817555
references: Ann Rheum Dis. 2009 Mar;68(3):310-7
references: 18413444
references: Bone Marrow Transplant. 2012 Mar;47(3):399-403
references: 21478917
references: Am J Transplant. 2005 Nov;5(11):2791-5
references: 16212642
references: Br J Haematol. 2014 Feb;164(4):469-80
references: 24372186
references: J Clin Invest. 1957 Apr;36(4):617-28
references: 13416392
references: Br J Haematol. 1985 Jan;59(1):159-69
references: 3970849
references: J Heart Lung Transplant. 2008 Nov;27(11):1198-202
references: 18971091