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A 6LJ-year-old female patient with cel iac disease and related dermatitis herpetiformis presents to the emergency room complai ning of fatigue and blue finger tips. She has been taking dapsone for approxima tely 3 months. CBC shows leukocyte count 9.500/,LLL. hemoglobin 7.5 g/dl. and platelet count 1 76 .000/,LLL. Laboratory informs you that the patien t has "green serum." as shown below.
What is the most likely diagnosis?
- Carboxyhemoglobinemia
- Methemoblobinemia
- Sulfhemoglobinemia
Medicine
C. The test tube shows green serum secondary to sulfhemoglobinemia. Sulfhemoglobin is a green-pigmented protein, and is been associated with the use of oxidant medications, occupational exposure to sulfur compounds, air pollution, and recreational drug abuse, and may cause oxidative hemolysis. Unlike for methemoglinemia, methylene blue is not effective for treatment, although most patients with sulfhemoglobinemia are asymptomatic. Methemoglobinemia is associated with choco-late brown blood, and carboxyhemoglobinemia may cause cherry or bright pink nails.
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