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Factitious methemoglobinemia.

K M Carr¹, L Elias, L C Caruana

¹Department of Internal Medicine, Division of Hematology and Medical Oncology, University of New Mexico School of Medicine and Cancer Research and Treatment Center, Albuquerque, New Mexico 87131-5636, USA.

American Journal of Hematology

|October 28, 1999

Summary

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A young woman repeatedly developed methemoglobinemia due to secret dapsone abuse, a behavior linked to factitious disorder. This case highlights the diagnostic challenges in identifying self-induced medical conditions.

Area of Science:

Internal Medicine
Toxicology
Psychiatry

Background:

Methemoglobinemia is a condition where hemoglobin is oxidized, reducing oxygen transport.
Dapsone is a medication with known potential to induce methemoglobinemia, especially in cases of overdose or abuse.

Observation:

A 26-year-old female presented with recurrent methemoglobinemia.
The patient had a history of numerous treatments for this condition.
The underlying cause was suspected to be surreptitious dapsone abuse.

Findings:

The recurrent methemoglobinemia was attributed to intentional, hidden abuse of dapsone.
Factitious disorder was identified as the likely psychiatric condition driving the self-harm behavior.

Implications:

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This case underscores the importance of considering factitious disorder in patients with unexplained, recurrent medical conditions.
Healthcare providers must maintain a high index of suspicion for surreptitious substance abuse in challenging diagnostic scenarios.
Multidisciplinary approaches involving internal medicine, toxicology, and psychiatry are crucial for effective management.