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Methaemoglobinaemia in an infant: case report A 16-month-old boy with molluscum contagiosum developed methaemoglobinaemia after topical application of a pomade containing benzocaine/hydroxyquinoline sulfate/resorcinol [Nestosyl]. The boy was brought in to the emergency department for sudden cyanosis. On arrival, he appeared agitated with a Glasgow Coma Scale score of 12/15; he was febrile and tachycardic, with an oxygen saturation of 76% on 3L of oxygen. Despite intubation and mechanical ventilation, his cyanosis persisted. Arterial blood gas analysis showed a pH of 7.57, PaO2 of 157.4mm Hg, PCO2 of 12.5mm Hg, HCO3 of 11.6 mmol/L, oxygen saturation of 99.7% and a methaemoglobin level of 50.6%. The boy received IV methylthioninium chloride [methylene blue] 1%. On questioning, the parents reported that 24 hours previously, approximately half a tube of Nestosyl had been applied to the boy’s face, thorax and limbs, which had molluscum contagiosum lesions [dosage not stated]. His subsequent clinical course was favourable; his cyanosis neurologic status and haemodynamic status rapidly improved, and after 24 hours, his methaemoglobin levels dropped to 9.8%. He was weaned from mechanical ventilation on hospital day 2 and was discharged from the paediatric ICU on day 3. Author comment: "In our case, toxic methemoglobinemia was induced by wide cutaneous application of Nestosyl pomade. . . Nestosyl contains butoform, benzocaine, resorcin, and 8-hydroxyquinoline: the latter three can induce methemoglobinemia." Bouziri A, et al. Unusual cause of severe toxic methemoglobinemia in an infant: A case report. International Journal of Emergency Medicine 3: 57-59, No. 1, Mar 2010. Available from: URL: http://dx.doi.org/10.1007/s12245-009-0149-0 803028610 Tunisia

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Reactions 31 Jul 2010 No. 1312