SHM Converge Scientific Abstract ePoster Gallery-Feeling Blue: Respiratory Distress in an Adolescent

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A 15-year-old girl with a history of acne and anxiety presented to the emergency department with acute severe shortness of breath, palpitations, and blue discoloration of her lips and fingertips after visiting a theme park. She had been using topical dapsone for acne and was taking sertraline 100 mg daily. On exam, she was tachycardic, tachypneic, anxious, mildly diaphoretic, and cyanotic despite normal lung sounds. Pulse oximetry was low at 85%, and an arterial blood gas helped confirm methemoglobinemia.<br /><br />Her condition was attributed to dapsone-induced methemoglobinemia, a disorder in which hemoglobin iron is oxidized from the ferrous to ferric state, preventing oxygen binding and causing a left shift in the oxygen dissociation curve. She was treated with 100% oxygen, methylene blue, and IV ascorbic acid. Because methylene blue can act as a monoamine oxidase inhibitor, she developed serotonin syndrome in the setting of concurrent SSRI use, which was managed with benzodiazepines.<br /><br />Her methemoglobin levels remained elevated, so cimetidine was started to reduce conversion of dapsone to its toxic metabolite. She was G6PD negative. The case highlights that topical dapsone, commonly used for acne, can cause clinically significant methemoglobinemia. Diagnosis relies on clinical suspicion, a saturation gap, and blood gas testing. Treatment is methylene blue when appropriate, but clinicians must be cautious in patients taking serotonergic medications due to the risk of serotonin syndrome.

Asset Subtitle

Camille Carre

Meta Tag

Author List Camille Carre, Sharon Dabrow

Category Clinical Vignettes

Concept Methemoglobinemia

Concept Methylene Blue

Concept Dapsone

Concept Serotonin Syndrome

Concept Dyspnea

Distinguished Non-Finalist

Presenter Organization University of South Florida Department of Pediatrics

Presenting Author Camille Carre

Track Pediatric

Keywords

methemoglobinemia

dapsone

serotonin syndrome

methylene blue

sertraline

acne treatment

cyanosis

saturation gap

G6PD deficiency

cimetidine

Methemoglobinemia

Methylene Blue

Dapsone

Serotonin Syndrome

Dyspnea