North Middlesex University Hospital, London, UK
Department of Renal Medicine, Hammersmith Hospitals NHS Trust, London, UK.
BMJ Case Rep. 2022 Mar 7;15(3):e247629. doi: 10.1136/bcr-2021-247629.
A man in his 20s presented with severe left-sided chest pain, shortness of breath and acute confusion. Initial examination revealed central cyanosis, normal heart sounds, vesicular breath sounds in both lung fields and a bruised right calf. The patient reported that he had recently injured his right leg and that he had not taken medication prescribed for blood clots for several days. Peripheral oxygen saturations were 85% despite high flow oxygen via a non-rebreather mask. ECG revealed sinus tachycardia. Arterial blood gas sampling confirmed hypoxaemia. Given the history and the severe hypoxia, he was managed for pulmonary embolism initially.Closer inspection of his arterial blood results showed a methaemoglobin percentage of 20.4%. He was given intravenous methylene blue which resulted in resolution of his symptoms within 30 min. He subsequently confirmed that he was undergoing genetic testing for likely congenital methaemoglobinaemia.
一位 20 多岁的男性患者出现严重的左侧胸痛、呼吸急促和意识模糊。初步检查显示中心性发绀，心音正常，双肺可闻及肺泡呼吸音，右小腿有瘀伤。患者报告说他的右腿最近受伤了，而且已经有几天没有服用医生开的治疗血栓的药物了。尽管通过无重复呼吸面罩给予高流量氧气，但外周血氧饱和度仍为 85%。心电图显示窦性心动过速。动脉血气采样证实存在低氧血症。鉴于病史和严重的低氧血症，他最初被诊断为肺栓塞。仔细检查他的动脉血气结果显示高铁血红蛋白百分比为 20.4%。给予静脉注射亚甲蓝后，他的症状在 30 分钟内得到缓解。随后他证实正在接受可能的先天性高铁血红蛋白血症的基因检测。
