title: Methemoglobinemia induced by topical vaginal sulfanilamide cream in a patient with cervical cancer: a case report.
abstract: BACKGROUND
  Methemoglobinemia is a rare disorder most commonly associated with the ingestion or topical application of an offending exogenous agent. The clinical consequences of acute methemoglobinemia can be devastating and include lethargy, headache, and dyspnea and, as methemoglobin concentrations rise, respiratory depression, confusion, seizures, and even death.
  
  
  METHODS
  Here we present a case of acute methemoglobinemia induced by exposure to topical vaginal sulfanilamide cream in a 36-year-old woman with a FIGO stage IIIB squamous cell cervical carcinoma.
  
  
  CONCLUSIONS
  Although methemoglobinemia associated with topical anesthetics has been well documented, to our knowledge this is the first reported case of methemoglobinemia induced by exposure to topical sulfanilamide cream. Although patients undergoing intracavitary radiation treatment for cervical cancer are at risk for cyanosis due to the development of deep vein thromboses and pulmonary embolism, methemoglobinemia should be suspected in the setting of acute cyanosis with a normal arterial oxygen pressure.
authors.affiliation: Department of Radiation Oncology, Unit 97, U.T. M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Bristol
authors.forename: Jubilee
authors.initials: J
authors.lastname: Brown
authors.forename: Brian M
authors.initials: BM
authors.lastname: Slomovitz
authors.forename: Vickie R
authors.initials: VR
authors.lastname: Shannon
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008708:Methemoglobinemia / Q000139:chemically induced*; D000077145:Sulfanilamide; D013424:Sulfanilamides / Q000008:administration & dosage / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000532:radiotherapy
chemical_list: D013424:Sulfanilamides; D000077145:Sulfanilamide