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Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia
We present a rare case of rasburicase-induced methemoglobinemia and hemolytic anemia in the setting of presumed glucose-6-phosphate dehydrogenase (G6PD) deficiency. A 78-year-old male with a known history of chronic lymphocytic leukemia presented to the clinic with fever of unknown origin. Laborator...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168055/ https://www.ncbi.nlm.nih.gov/pubmed/30324040 http://dx.doi.org/10.7759/cureus.3084 |
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author | Younis, Moustafa Derbas, Laith Eikermann, Stephen M Hamarshi, Majdi S |
author_facet | Younis, Moustafa Derbas, Laith Eikermann, Stephen M Hamarshi, Majdi S |
author_sort | Younis, Moustafa |
collection | PubMed |
description | We present a rare case of rasburicase-induced methemoglobinemia and hemolytic anemia in the setting of presumed glucose-6-phosphate dehydrogenase (G6PD) deficiency. A 78-year-old male with a known history of chronic lymphocytic leukemia presented to the clinic with fever of unknown origin. Laboratory results were significant for hyperuricemia. He was empirically started on levofloxacin and rasburicase. He then presented to the emergency department with shortness of breath and syncope. Physical examination was remarkable for a fever of 102.8 °F, conjunctival pallor, and scleral icterus. An infiltrate was observed on his computed tomography (CT) angiogram of the chest. Arterial blood gas on 50% fraction of inspired oxygen was significant for an arterial oxygen level of 222 millimeters mercury and oxyhemoglobin of 85.9%. Co-oximetry was then obtained and methemoglobin level was 13.4%. Laboratory results were noteworthy for a drop-in hemoglobin, indirect hyperbilirubinemia, low haptoglobin and elevated lactate dehydrogenase; depicting hemolytic anemia. The patient received two units of packed red blood cells, intravenous broad-spectrum antibiotics and he clinically improved. |
format | Online Article Text |
id | pubmed-6168055 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-61680552018-10-15 Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia Younis, Moustafa Derbas, Laith Eikermann, Stephen M Hamarshi, Majdi S Cureus Internal Medicine We present a rare case of rasburicase-induced methemoglobinemia and hemolytic anemia in the setting of presumed glucose-6-phosphate dehydrogenase (G6PD) deficiency. A 78-year-old male with a known history of chronic lymphocytic leukemia presented to the clinic with fever of unknown origin. Laboratory results were significant for hyperuricemia. He was empirically started on levofloxacin and rasburicase. He then presented to the emergency department with shortness of breath and syncope. Physical examination was remarkable for a fever of 102.8 °F, conjunctival pallor, and scleral icterus. An infiltrate was observed on his computed tomography (CT) angiogram of the chest. Arterial blood gas on 50% fraction of inspired oxygen was significant for an arterial oxygen level of 222 millimeters mercury and oxyhemoglobin of 85.9%. Co-oximetry was then obtained and methemoglobin level was 13.4%. Laboratory results were noteworthy for a drop-in hemoglobin, indirect hyperbilirubinemia, low haptoglobin and elevated lactate dehydrogenase; depicting hemolytic anemia. The patient received two units of packed red blood cells, intravenous broad-spectrum antibiotics and he clinically improved. Cureus 2018-08-01 /pmc/articles/PMC6168055/ /pubmed/30324040 http://dx.doi.org/10.7759/cureus.3084 Text en Copyright © 2018, Younis et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Internal Medicine Younis, Moustafa Derbas, Laith Eikermann, Stephen M Hamarshi, Majdi S Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title | Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title_full | Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title_fullStr | Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title_full_unstemmed | Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title_short | Not the Typical Pneumonia: An Unusual Case of Rasburicase-induced Methomoglobinemia |
title_sort | not the typical pneumonia: an unusual case of rasburicase-induced methomoglobinemia |
topic | Internal Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168055/ https://www.ncbi.nlm.nih.gov/pubmed/30324040 http://dx.doi.org/10.7759/cureus.3084 |
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