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Dapsone is a leprostatic agent commonly prescribed for the management of leprosy, malaria, and the immunosuppression-induced infections of Pneumocystis carinii and Toxoplasma gondii . In susceptible patients, methemoglobinemia, a potentially life-threatening event, can occur. We report a case of dapsone-induced methemoglobinemia which was observed during general anesthesia for the management of a fractured mandible. CASE REPORT A 56-year-old Asian woman presented for the treatment of a fracture of the body of

dose as low as 500 mg for major nerve block. 8 Methemoglobinemia has been also reported after topical use of a eutectic mixture of the local anesthetics lidocaine and prilocaine in children. 9 Other commonly used drugs known to cause methemoglobinemia are phenacetin, acetaminophen, vasodilators, sulfonamides, and dapsone. Oxidizing Agents Known to Induce Methemoglobinemia The diagnosis of methemoglobinemia in our patient was suggested by the occurrence of cyanosis that did not improve with increasing

mechanisms. This results in higher than normal blood levels of methemoglobin, causing the condition known as acquired methemoglobinemia. 4 , 11 Examples of medications that may cause elevated methemoglobin levels include nitrates (nitroglycerin), nitrites (amyl nitrite), antiemetics (metoclopramide), antibiotics (trimethoprim, sulfonamides, and dapsone), and local anesthetics (prilocaine and benzocaine). 4 , 8 – 10 , 12 The liberal use of benzocaine in infant teething gels and topical anesthetic sprays is a concern. 4 , 5 , 8 – 10 , 12 Exposure to industrial agents can