Sulfhemoglobinemia after dermal application of DMSO.
A 43-y-old Caucasian female applied 4 ounces of dimethyl sulfoxide (DMSO) to her lower abdomen for treatment of interstitial cystitis. Within 24 h she developed fatigue, cyanosis and dyspnea with mild exertion. She sought medical attention 10 d later, at which time initial laboratory tests revealed a methemoglobin level of 47%. Two doses of 1 mg methylene blue/kg i.v. were given without significant improvement in either her cyanosis or methemoglobin level. Repeat analysis the day following admission using an outside lab demonstrated a sulfhemoglobin level of 6.2% and a methemoglobin level of < 0.1%. No prior reports have associated sulfhemoglobin formation with DMSO application. Carbon monoxide-oximetry may falsely identify sulfhemoglobin as methemoglobin; sulfhemoglobinemia should be considered in cases of methemoglobinemia refractory to methylene blue therapy.
Burgess
J L
JL
Washington Poison Center, Seattle 98125-8012, USA.
Hamner
A P
AP
Robertson
W O
WO
D000287:Administration, Topical; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002248:Carbon Monoxide / Q000032:analysis; D018856:Cystitis, Interstitial / Q000097:blood / Q000188:drug therapy; D003951:Diagnostic Errors; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008706:Methemoglobin / Q000032:analysis*; D008708:Methemoglobinemia / Q000139:chemically induced / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D013435:Sulfhemoglobin / Q000032:analysis*; D013436:Sulfhemoglobinemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy
D000892:Anti-Infective Agents, Urinary; D000893:Anti-Inflammatory Agents; D002248:Carbon Monoxide; D008706:Methemoglobin; D013435:Sulfhemoglobin; D008751:Methylene Blue; D004121:Dimethyl Sulfoxide