Methemoglobinemia in postchemotherapy stomatitis topical treatment: 2 pediatric cases

J Pediatr Hematol Oncol. 2012 Mar;34(2):137-9. doi: 10.1097/MPH.0b013e3182172532.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Administration, Topical
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / adverse effects*
  • Anti-Bacterial Agents / administration & dosage
  • Antifungal Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • Benzocaine / administration & dosage
  • Benzocaine / adverse effects*
  • Child
  • Doxycycline / administration & dosage
  • Drug Combinations
  • Gels
  • Glycerol / administration & dosage
  • Humans
  • Infant
  • Kidney Neoplasms / drug therapy
  • Male
  • Methemoglobinemia / chemically induced*
  • Methemoglobinemia / physiopathology
  • Neuroblastoma / drug therapy
  • Nystatin / administration & dosage
  • Stomatitis / chemically induced
  • Stomatitis / drug therapy*
  • Wilms Tumor / drug therapy

Substances

  • Anesthetics, Local
  • Anti-Bacterial Agents
  • Antifungal Agents
  • Antineoplastic Agents
  • Drug Combinations
  • Gels
  • Nystatin
  • Doxycycline
  • Glycerol
  • Benzocaine