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The painted shoes.

Natália Noronha1, André Rosa Alexandre2, Joana Cavaca Santos1

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A child developed methemoglobinemia from aniline shoe dye, presenting with cyanosis and low oxygen. Prompt treatment with methylene blue led to a full recovery.

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Area of Science:

  • Pediatric Toxicology
  • Emergency Medicine
  • Clinical Chemistry

Background:

  • Methemoglobinemia is a condition where hemoglobin is oxidized, reducing oxygen-carrying capacity.
  • Aniline dyes, found in some consumer products, are a known cause of acquired methemoglobinemia.

Observation:

  • A previously healthy 4-year-old boy presented with severe cyanosis, pallor, vomiting, and hypoxia despite oxygen therapy.
  • Clinical examination revealed tachypnea and a systolic heart murmur. A history of painted shoes raised suspicion for toxic exposure.

Findings:

  • The patient was diagnosed with methemoglobinemia, presumed to be caused by exposure to aniline-containing shoe dye.
  • Treatment with methylene blue rapidly decreased methemoglobin levels and reversed the clinical symptoms.

Implications:

  • This case highlights the importance of considering toxic ingestions and exposures in pediatric emergencies, even with seemingly benign exposures.
  • Early recognition and prompt administration of the antidote, methylene blue, are crucial for favorable outcomes in methemoglobinemia.
  • Environmental and occupational health awareness is vital to prevent such accidental poisonings, especially in children.