A Case of Acute Hemolytic Anemia and Methemoglobinemia Induced by Massive Dapsone Intoxication / 대한혈액학회지

Dapsone toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. We experienced a case of acute massive dapsone intoxication in 34 years old man due to voluntary ingestion of 25g of this drug as a suicide attempt. A severe methemoglobinemia developed, accompanied by nausea, vomiting, intense cyanosis, headache, and dyspnea. Subsequently moderate hemolytic anemia observed. The patient recovered completely after intensive treatment with methylene blue, activated charcoal hemoperfusion, oral charcoal ingestion, steroid, and conservative treatment. Methylene blue was given by continuous intravenous infusion in order to avoid overdosage. We herein report a case of the acute hemolytic anemia and severe methemoglobinemia induced by massive dapsone intoxication with a review of the literature.

A Case of Undifferenciated Large Cell Carcinoma of Lung Associated with Neurofibromatosis / 대한내과학회지

Neurofibromatosis also referred to as von Recklinghausen`s disease, is an autosomal dominant disease, which is characterized by cutaneous neurofibromas, cafe-au-lait spot, and axillary freckles. Although neruofibromatosis is a congenital disorder, the pulmonary manifestation become evident in adulthood. Approximately 15percent of patients with cutaneous lesions have intrathoracic neurofibromas. In some patients with neurofibromatosis, the lungs are the seat of interstitial fibrosis, leiomyoma, and bullous lesion, meningocele or less commonly lung cancer. The association of neurofibromatosis and lung cancer is rare, A 47-year-old man, who was a heavy smoker, was admitted to our hospital because of hemoptysis. Since cafe-au-lait sopts, diffuse pigmentation and multiple neurofibromatosis were observed on the skin, he was considered to have von Recklinghausen`s disease. Chest X-ray film showd extensive hazy density affecting all of his lung field, and minimal peribronchial infiltratin in his left lower lung field. Chest CT showed that near total consolidative lesions were present of right middle lobe. Also, some patchy infiltration were present in his right lower lobe and some of left lower lobe. Histoathological examination of the percutaneous lung biopsy specimen demonstrated that he had undifferentiated large cell carcinoma. The Authors have experienced a case of neurofibromatosis combined with undifferntiated large cell carcinoma. A brief review of related literature was conducted.