Blogfinger

By Paul Goldfinger MD, FACC

The patient was a middle aged woman who worked in the bank on Blackwell Street in Dover , New Jersey, where I had recently opened my practice.   People began to notice a change in her appearance: she had developed a bluish discoloration of her skin.  Each day it became worse and worse until her friends and family became alarmed. Although she had no symptoms, the time had come to contact her family physician.

I got a call about her from her doctor, a kindly older man who smoked cigarettes in his office and dropped ashes on his vest. “Paul” he said,  “I want you to see this lady who’s turning blue.”

I was stunned.  Middle aged females don’t just turn blue out of the blue.  I could see why he might want a cardiologist, but how could his patient have such a heart condition when she felt fine?

She came to the E.R. at Dover General Hospital where I met her. She was indeed cyanotic*, but the cause was not obvious.  I admitted her to the hospital where it became clear that she had neither heart disease or lung disease—the two leading causes of cyanosis.

All the tests were negative, so I decided to go back to basics— there had to  be a clue in her history.   As I was going over all the particulars again, she mentioned something that she hadn’t disclosed when I first met her:  she was being treated for a urinary tract infection.  When I looked up her medication, I discovered that her pyridium could cause a change in her blood hemoglobin to produce a compound called methemoglobin.  So instead of red blood, her blood was turning blue.

Eureka!  The lab ran a methemoglobin level on her blood,  and we had the diagnosis: methemoglobinemia—the first and last case I ever saw.

We  stopped the pyridium and kept her in the hospital.   Each day  when I made rounds, I became more and more relieved—she was turning lighter and lighter blue each day. As her hue returned toward normal, I became confident that she would be cured.

After that we could relax, so on rounds  I would sing her a few bars of the chorus to this song:  (performed here by Ethel Waters in 1929).  She eventually went home–a normal white woman, and I had a story to tell : over and over.

(*Cyanosis is a bluish discoloration of the skin)