Extracorporeal Treatments In A Dapsone Overdose: A Case Report

Introduction: Intentional dapsone intoxication can be life-threatening. There is limited data on the clinical effect of extracorporeal treatments (ECTRs) on dapsone elimination. We describe a case of severe dapsone toxicity treated with different ECTRs.Case details: A 23-year-old woman was admitted 2.5h after ingesting 2.2g of dapsone. She developed methemoglobinemia (39.9%) and showed signs of toxicity (hemodynamic instability and altered mental status) despite multiple-activated charcoal, methylene blue, vasopressors and endotracheal intubation. Continuous venovenous hemofiltration (CVVH) was then initiated for 5h, followed by intermittent hemodialysis with hemoperfusion (IHD-HP) for 4h, and CVVH for another 48h. The platelet count decreased to 32x10(9)/L 3h after IHD-HP. The elimination half-life of dapsone was 2.0h during IHD-HP, and 14.2h during CVVH. Mean dapsone clearance with IHD was 62mL/min versus 22mL/min with CVVH. IHD removed 95.3mg, and CVVH removed 67.8mg over 3.8h. No rebound occurred following ECTR cessation. The toxicokinetics of dapsone metabolites were also accelerated during ECTR. The patient was extubated after 3.5days and discharged without sequelae after 7days.Discussion: Dapsone clearance was enhanced by ECTR, especially by IHD-HP. However, HP was associated with severe asymptomatic thrombocytopenia.