The patient continues to be immunosuppressed related to functional asplenia due to transplant, continued systemic immunosuppression for control of her chronic GVHD symptoms, and intermittent steroid use for worsening GVHD flares. As such, she requires PCP prophylaxis and due to intolerance was on Dapsone for this purpose- a drug known to increase risk for methemoglobinemia. She was tolerating this well in and of itself, but then received Novocaine for the dental extractions and used Orajel (benzocaine) at home for pain management. The combination lead to the methemoglobinemia.
The methemoglobinemia was confirmed as a moderate case via the potassium cyanide test.
Echocardiogram showed the pericardial effusion, mild mitral valve regurgitation, and an ejection fraction of 60%.
Given all of these issues, what treatment would you anticipate? How would response to therapy be monitored?