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KMID : 1013220060040020170
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Jouranl of the Korean Society of Clinical Toxicology
2006 Volume.4 No. 2 p.170 ~ p.174
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A Case of Acute Dapsone Poisoning Complicated with Methylene Blue-induced Hemolytic Anemia
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Lee Mi-Jin
Park Kyu-Nam
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Abstract
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Methylene blue is a basic thiazine dye frequently used for histologic staining. In clinical toxicology settings, it is also used to treat clinically significant methemoglobinemia. It has dose-dependent oxidation or reduction properties, acting as a reducing agent at lower doses and as an oxidizing agent at higher doses. Hemolytic anemia and hyperbilirubinemia are known toxic effects of methylene blue treatment that have been reported clinically. A 42-year-old woman developed significant methemoglobinemia after acute dapsone overdose; she was treated appropriately with intravenous methylene blue in the therapeutic range. The patient’’s methemoglobin levels returned to normal. However, 2-4 days later she was noted to have rebound methemoglobinemia, hemolytic anemia, and hyperbilirubinemia. A repeat of Coomb’’s test and other anemia workups were negative. For management of methylene blue-induced hemolytic anemia, she was administered steroid therapy, N-acetylcysteine, and a blood transfusion. She ultimately recovered, and there were no long-term sequelae from the methylene blue poisoning.
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KEYWORD
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Methylene blue, Hemolytic anemia, Dapsone, Poisoning
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