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Methemoglobinemia in Postchemotherapy Stomatitis Topical Treatment: 2 Pediatric Cases

Kaczorowska-Hac, Barbara MD; Stefanowicz, Joanna MD; Stachowicz-Stencel, Teresa MD; Kozlowska, Marta MD; Adamkiewicz-Drozynska, Elzbieta PhD; Balcerska, Anna PhD

Journal of Pediatric Hematology/Oncology: March 2012 - Volume 34 - Issue 2 - p 137–139
doi: 10.1097/MPH.0b013e3182172532
Clinical and Laboratory Observations

Methemoglobinemia is a rare congenital or acquired disease of increased blood methemoglobin concentration. We documented 2 cases of children suffering from neuroblastoma whose postchemotherapy anemia, leucopenia, and stomatitis were complicated by methemoglobinemia after using a formulary oral gel (7.5% benzocaine, doxycycline, nystatin, glycerin). The complication resulted in hospital treatment. Percutaneous oxygen saturation remained at 85% and 87% despite administration of 100% oxygen through a nonrebreather mask. Arterial blood gas analysis showed an oxygen saturation of 98% and 97%, respectively. Spectroscopic measurement showed methemoglobin concentration of 42% and 35.5%, respectively. After red blood cell transfusion and oral ascorbic acid in case 1 and methylene blue in case 2, the patients’ condition improved. Although the benzocaine gel is not in use in several medical systems, it should be considered as a possible reason for methemoglobinemia.

Department of Hematology, Oncology and Endocrinology, Medical University of Gdansk, Poland

The authors declare no conflict of interest.

Reprints: Barbara Kaczorowska-Hac, MD, Department of Hematology, Oncology, and Endocrinology, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland (e-mail:

Received December 25, 2010

Accepted February 23, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.