Acquired methohemoglobinemia may be frequently encountered in rural India. This case report throws light on the essence of timely diagnosis and intervention where the immediate administration of the cost effective but life saving antidote of methylene blue can make a difference in saving the patient’s life and preventing further complications.

Keywords: Methemoglobinemia, nitrobenzene, methylene blue.

1. Manabe J, Arya R, Sumimoto H, et al. Two novel mutations in the reduced nicotinamide adenine dinucleotide (NADH)-cytochrome b₅reductase gene of a patient with generalized type, hereditary methemoglobinemia.  Blood 1996;88: 3208-3215. [PubMed]
2. Yawata Y, Ding L, Tanishima K, Tomoda A. New variant of cytochrome b₅reductase deficiency (b5Rkurashiki) in red cells, platelets, lymphocytes, and cultured fibroblasts with congenital methemogl-obinemia, mental and neurological retardation, and skeletal anomalies. Am J Hematol 1992;40: 299-305. [PubMed]
3. Khemiri M, Labassi A Jr, Bagais A Jr, et al. Toxic methemoglobinemia due to ibuprofen: report of a pediatric case. J Emerg Med. 2010;39:216-7.
4. Boilerbaisse: an outbreak of methemoglobinemia in New Jersey in 1992. Askew GL, Finelli L, Genese CA, Sorhage FE, Sosin DM, Spitalny KCPediatrics. 1994 Sep; 94(3):381-4.
5. Rees SM, Nelson LS. Dyshemoglobine-mias. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergency medi-cine a comprehensive study guide. New York: McGraw-Hill; 2004. pp. 1169–1171
6. Rosen PJ, Johnson C, McGehee WG, Beutler E. Failure of methylene blue treatment in toxic methemoglobinemia. Association with glucose-6-phosphate dehydrogenase deficiency. Ann Intern Med Jul;75(1):83-86 10.7326/ 0003- 4819 -75-1-83
7. Verive M, Kumar M. Methemglobinemia: Treatment and Medication, e medicine from web med. Available from: http://www.emedicine.medscape.com/article/956528-treatment[cited in 2010]
8. Dutta R, Dube SK, Mishra LD, Singh AP. Acute methemglobinemia. Internet J Emerg Intensive Care Med. 2008; 11:1092–4051.

Gupta G, Poddar B, Salaria M, Parmar V. Acute nitrobenzene poisoning.  Indian Pediatr. 2000; 37:1147–8.

Dr Indhuja.K

Postgraduate, Department of General Medicine, Rajah Muthiah  Medical College and Hospital, 

Annamalai University, Annamalai Nagar – 608002