A Boy with Nephrotic Syndrome and Methemoglobinemia: A Diagnostic Challenge
Journal of Pediatric Nephrology,
Vol. 9 No. 2 (2021),
,
Page 1-5
https://doi.org/10.22037/jpn.v8i2.33031
Abstract
Methemoglobinemia is a rare disease characterized by the elevated levels of methemoglobinin the blood. It may be congenital or acquired. Co-trimoxazole is an antibiotic that belongs to the sulfone
group. Sulfone group drugs may produce drug-induced acquired methemoglobinemia. Methemoglobin is an oxidized form of hemoglobin that has an increased affinity to oxygen and a reduced ability to release oxygen to tissues. High levels of methemoglobin inred blood cells cause tissue hypoxia. This disorder may present with
several symptoms such as cyanosis, fatigue, dyspnea, and headache. Because it is a rare cause of cyanosis and hypoxemia, the diagnosis of methemoglobinemia is often delayed. We herein discuss a five-year-old boy with steroid-resistant nephrotic syndrome who presented with exertional dyspnea and cyanosis and was later diagnosed as a case of co-trimoxazole-induced methemoglobinemia.
Keywords:
- Methemoglobinemia
- Co-trimoxazole
- Nephrotic Syndrome
- Child
How to Cite
1.
Sultana A, Roy RR, Muinuddin G, Khan MAH, Mahmud S. A Boy with Nephrotic Syndrome and Methemoglobinemia: A Diagnostic Challenge. J Ped Nephrol [Internet]. 2021Mar.31 [cited 2022Jul.4];9(2):1-. Available from: https://journals.sbmu.ac.ir/jpn/article/view/33031
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9. Medina I, Mills J, Leoung G, Hopewell PC, Lee B, Modin G, et al. Oral therapy for pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim- dapsone. N Engl J Med. 1990;323:776-82.
10. Prchal JT. Clinical features, diagnosis, and treatment of methemoglobinemia. Waltham, MA: UpToDate; 2014. Available from:www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-methemoglobinemia. Accessed 2014 Dec 7.
11. Ward KE, McCarthy MW. Dapsone-induced methemoglobinemia. Ann Pharmacother. 1998 May. 32(5):549-53.
12. Srinivasan R, Ramya G. Adverse drug reaction-causality assessment. IJRPC 2011; 1:606-12.
13. Abu-Laban, R.B, Zed, P.J., Purssell, R.A, and Evans, K.G. Severe Methemoglobinemia from topical anesthetic spray: Case report, discussion and qualitative systemic review. Canadian Journal of Emergency Medicine. 2001; 3: 51–56.
14. Ashurst JV, Wasson MN, Hauger W, Fritz WT. Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia. J Am Osteopath Assoc 2010; 110:16-20
15. . Steiner IP, Nichols DN. A case of dapsone – Induced cyanosis in the emergency department. Isr J Emerg Med 2006; 6:10-3.
2. Michael Stewart, Sid Dajani|. Co-trimoxazole for infection. Medicines ,Infection Treatment Medicine journal.2012; 5:28-30
3. Davis CA, Crowley LJ, Barber MJ. Cytochrome b5 reductase: The roles of the recessive congenital methemoglobinemia mutants P144L, L148P, and R159*. Arch Biochem Biophys. 2004; 431:233–244.
4. Da-Silva SS, Sajan IS, Underwood JP III. Congenital methemoglobinemia: A rare cause of cyanosis in the newborn—a case report. Pediatrics. 2003; 112(2). Available at: www.pediatrics.
5. Abu-Laban, R.B, Zed, P.J., Purssell, R.A, and Evans, K.G. Severe Methemoglobinemia from topical anesthetic spray: Case report, discussion and qualitative systemic review. Canadian Journal of Emergency Medicine. 2001; 3: 51–56.
6. Prchal JT. Clinical features, diagnosis, and treatment of methemoglobinemia. Waltham, MA: UpToDate; 2014. Available from: www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-methemoglobinemia. Accessed 2014 Dec 7.
7. Wright, R.O., Lewander, W.J., and Woolf, A.D. Methemoglobinemia: Etiology, pharmacology, and clinical management. Annuals of emergency Medicine. 1999; 34: 646–656
8. Nita Radhakrishnan and Ruchi Rai. Cotrimoxazole-induced Methemoglobinemia. Indian Pediatr 2017;54(9): 786-787
9. Medina I, Mills J, Leoung G, Hopewell PC, Lee B, Modin G, et al. Oral therapy for pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim- dapsone. N Engl J Med. 1990;323:776-82.
10. Prchal JT. Clinical features, diagnosis, and treatment of methemoglobinemia. Waltham, MA: UpToDate; 2014. Available from:www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-methemoglobinemia. Accessed 2014 Dec 7.
11. Ward KE, McCarthy MW. Dapsone-induced methemoglobinemia. Ann Pharmacother. 1998 May. 32(5):549-53.
12. Srinivasan R, Ramya G. Adverse drug reaction-causality assessment. IJRPC 2011; 1:606-12.
13. Abu-Laban, R.B, Zed, P.J., Purssell, R.A, and Evans, K.G. Severe Methemoglobinemia from topical anesthetic spray: Case report, discussion and qualitative systemic review. Canadian Journal of Emergency Medicine. 2001; 3: 51–56.
14. Ashurst JV, Wasson MN, Hauger W, Fritz WT. Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia. J Am Osteopath Assoc 2010; 110:16-20
15. . Steiner IP, Nichols DN. A case of dapsone – Induced cyanosis in the emergency department. Isr J Emerg Med 2006; 6:10-3.
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