{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:40:04Z","timestamp":1756316404617,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,24]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Methaemoglobinaemia occurs when iron in haemoglobin is oxidised into a form that cannot transport oxygen. At low levels, it is asymptomatic, though at rising levels symptoms arise from impaired oxygenation, and it can ultimately be fatal. While uncommon, it is important to consider in hypoxaemic COVID-19 patients, especially if they are not clinically improving on standard treatments and workup for other causes does not explain the ongoing hypoxaemia. It is often diagnosed through a mismatch in peripheral and arterial oxygen, with the former typically less than the latter. We present the case of a COVID-19 patient who was found to have methaemoglobinaemia due to dapsone use for Pneumocystic jirovecii pneumonia (PJP) prophylaxis while on chemotherapy. Dapsone was stopped and supplemental high-flow nasal cannula was provided, and methaemoglobin levels improved over a 5-day period. She was discharged to follow-up with her haematologist in the clinic.<\/jats:p>","DOI":"10.1136\/bcr-2023-256574","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T03:45:25Z","timestamp":1704858325000},"page":"e256574","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Detection of methaemoglobinaemia in a COVID-19 patient on dapsone"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9760-1042","authenticated-orcid":false,"given":"Fatima","family":"Chagani","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha","family":"Bansari","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhagwan","family":"Dass","sequence":"additional","affiliation":[{"name":"University of Florida Health, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"2025082710154277000_17.1.e256574.1","doi-asserted-by":"crossref","first-page":"e729","DOI":"10.1097\/MJT.0b013e318217a5af","article-title":"Symptomatic-low grade methemoglobinemia because of dapsone","volume":"20","author":"Skold","year":"2013","journal-title":"Am J Ther"},{"key":"2025082710154277000_17.1.e256574.2","unstructured":"Ludlow JT , Wilkerson RG , Nappe TM . Methemoglobinemia. Treasure Island (FL): StatPearls Publishing, 2020."},{"key":"2025082710154277000_17.1.e256574.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2006.11.016"},{"key":"2025082710154277000_17.1.e256574.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70167-8"},{"key":"2025082710154277000_17.1.e256574.5","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1002\/ajh.26340","article-title":"Recommendations for diagnosis and treatment of methemoglobinemia","volume":"96","author":"Iolascon","year":"2021","journal-title":"Am J Hematol"},{"key":"2025082710154277000_17.1.e256574.6","doi-asserted-by":"crossref","first-page":"A1131","DOI":"10.1016\/j.chest.2022.08.896","article-title":"Dapsone-induced methemoglobinemia in COVID-19: a mimic of \"happy hypoxia\"","volume":"162","author":"Sharma","year":"2022","journal-title":"Chest"},{"key":"2025082710154277000_17.1.e256574.7","doi-asserted-by":"crossref","first-page":"A2259","DOI":"10.1016\/j.chest.2022.08.1871","article-title":"Refractory hypoxemia: A case of Dapsone-induced Methemoglobinemia in A patient with COVID-19","volume":"162","author":"Alonso","year":"2022","journal-title":"Chest"},{"key":"2025082710154277000_17.1.e256574.8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.amjms.2021.04.020","article-title":"Methemoglobinemia in COVID-19","volume":"362","author":"Sahu","year":"2021","journal-title":"Am J Med Sci"},{"key":"2025082710154277000_17.1.e256574.9","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1056\/NEJM196811212792102","article-title":"Methemoglobinemia provoked by malarial chemoprophylaxis in Vietnam","volume":"279","author":"Cohen","year":"1968","journal-title":"N Engl J Med"},{"key":"2025082710154277000_17.1.e256574.10","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.3201\/eid2609.202353","article-title":"Methemoglobinemia in patient with G6Pd deficiency and SARS-COV-2 infection","volume":"26","author":"Palmer","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2025082710154277000_17.1.e256574.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-015-0984-8","article-title":"Pulse oximetry","volume":"19","author":"Jubran","year":"2015","journal-title":"Crit Care"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256574","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:15:47Z","timestamp":1756314947000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,9]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bcr-2023-256574"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256574","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}