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Woman with dyspnea, nausea, and malaise.

Article Excerpt
A 51-year-old woman presented to the emergency department in respiratory distress. She complained that during the previous 72 hours, she had experienced flu-like symptoms consisting of nausea and abdominal cramping, low-back pain and generalized muscle aches, low-grade fever, night sweats, and excessive fatigue. During the previous 24 hours, she had also developed shortness of breath with exertion, increasing in intensity.

The patient's medical history included mild depression, for which she was taking paroxetine hydrochloride, and granuloma annulare of the feet (a chronic skin condition), treated with dapsone prescribed by a dermatologist. She had been taking paroxetine for several months and dapsone for four weeks. The patient had no known medication allergies and denied having used any household cleaners, OTC medications, or herbal remedies in the past several weeks.

The physical examination showed a clear lung field to auscultation; heart rate and rhythm were normal, with a slightly elevated pulse rate of 92 beats/min. She was dyspneic, with a dusky color around her lips, and she used accessory muscles with respiration. Chest and abdominal x-ray films showed no abnormalities. Cardiac enzymes, electrolytes, and platelets were all within normal limits.

Arterial blood gas analysis results were pH, 7.62; PC[O.sub.2], 21 mm Hg; P[O.sub.2], 78 mm Hg; S[O.sub.2] saturation, 88% (normal is 90% or higher); and methemoglobin, 7% (a normal range is 0% to 1%). A complete blood cell count showed a hemoglobin level of 8.9 g/dL--a dramatic drop since a regular office visit four weeks prior, when it was 12.0 g/dL.

Based on the results of the arterial blood gas analysis, the patient was given a diagnosis of methemoglobinemia. She was admitted to the...