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Methemoglobinemia and hemolytic anemia associated with Campylobacter jejuni enteritis
M A Smith1, N R Shah, J S Lobel
1Department of Pediatric Subspecialties and Pediatric Cardiology, Geisinger Medical Center, Danville, PA 17822.
Insights
A Campylobacter jejuni infection was linked to methemoglobinemia in an infant. Treatment with erythromycin resolved both the infection and methemoglobinemia, suggesting a causal relationship.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Infectious Diseases
Background:
- Methemoglobinemia is a rare condition in infants, characterized by inadequate weight gain and hemolytic anemia.
- Common causes of methemoglobinemia, including genetic disorders and drug exposure, were ruled out in this case.
- A twin study design was employed, with one twin exhibiting symptoms and the other serving as a control.
Observation:
- A 7-week-old infant presented with methemoglobinemia, hemolytic anemia, and poor weight gain.
- The infant was diagnosed with a Campylobacter jejuni gastrointestinal infection.
- The patient's twin, presumed identical, did not present with these symptoms or infection.
Findings:
- The infant's methemoglobinemia and Campylobacter jejuni infection resolved following erythromycin treatment.
- The exclusion of other known causes and the control provided by the twin suggest a direct association between C. jejuni and methemoglobinemia.
- This case supports previous observations linking enteritis with methemoglobinemia in infants.
Implications:
- This study highlights a potential novel etiology for methemoglobinemia in infants.
- Early diagnosis and treatment of Campylobacter jejuni infections may prevent or resolve methemoglobinemia.
- Further research is warranted to elucidate the pathogenic mechanisms linking C. jejuni to methemoglobinemia.
Abstract:
A 7-week-old infant with methemoglobinemia, hemolytic anemia, and inadequate weight gain was found to have a Campylobacter jejuni gastrointestinal tract infection. Known etiologies of methemoglobinemia such as oxidative drug exposure, deficiency of NADH-methemoglobin reductase, and hemoglobin M disorder were excluded. The patient had a twin brother (probably identical) who had neither methemoglobinemia nor stool cultures positive for C. jejuni. The twin essentially served as an experimental control, making other environmental or genetic causes of methemoglobinemia unlikely in the patient. Both the methemoglobinemia and the C. jejuni infection responded to adequate treatment with erythromycin. The association of a C. jejuni infection with methemoglobinemia is discussed in light of previous associations of enteritis and methemoglobinemia in infants.