Methaemoglobinaemia: a rare cause of chest pain, hypoxia and cyanosis

A man in his 20s presented with severe left-sided chest pain, shortness of breath and acute confusion. Initial examination revealed central cyanosis, normal heart sounds, vesicular breath sounds in both lung fields and a bruised right calf. The patient reported that he had recently injured his right...

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Bibliographic Details
Published in:BMJ case reports 2022-03, Vol.15 (3), p.e247629
Main Authors: Gafaar, Babatunde, Olaitan, Ademola, Ahmed, Fahel, Ravi, Bharadwaj
Format: Article
Language:English
Subjects:
Cardiac arrhythmia
Case reports
Case Reports: Reminder of important clinical lesson
Chest Pain - drug therapy
Chest Pain - etiology
Congenital diseases
Cyanosis - etiology
Cytochrome
Disease
Drug dosages
Electrocardiography
Enzymes
Heart
Hematology
Hemoglobin
Hospitals
Humans
Hypoxia
Hypoxia - drug therapy
Hypoxia - etiology
Male
Methemoglobinemia - complications
Methemoglobinemia - diagnosis
Methemoglobinemia - drug therapy
Methylene Blue - therapeutic use
Pain
Patients
Pneumothorax
Pulmonary embolisms
Thromboembolism
Ultrasonic imaging
Citations: Items that this one cites
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Summary:A man in his 20s presented with severe left-sided chest pain, shortness of breath and acute confusion. Initial examination revealed central cyanosis, normal heart sounds, vesicular breath sounds in both lung fields and a bruised right calf. The patient reported that he had recently injured his right leg and that he had not taken medication prescribed for blood clots for several days. Peripheral oxygen saturations were 85% despite high flow oxygen via a non-rebreather mask. ECG revealed sinus tachycardia. Arterial blood gas sampling confirmed hypoxaemia. Given the history and the severe hypoxia, he was managed for pulmonary embolism initially.Closer inspection of his arterial blood results showed a methaemoglobin percentage of 20.4%. He was given intravenous methylene blue which resulted in resolution of his symptoms within 30 min. He subsequently confirmed that he was undergoing genetic testing for likely congenital methaemoglobinaemia.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-247629