Methemoglobinemia historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

• It has been reported (Heard & Ashworth 1968 apud Basrani et al. 2007) that, when placed in an aqueous solution, Chlorhexidine Gluconate (antiseptic) slowly hydrolyzes and forms para-chloroaniline (4-Chloroaniline, p-Chloroaniline or PCA). Para-chloroaniline (PCA) has been shown to be toxic. As an aromatic amine, the primary toxic effect is methemogloblin formation. Toxicological studies in rats and mice have shown that the hemopoietic system is the major target for PCA.

• There haven’t been reported any major outbreaks of methemoglobemia.

• In 1990, Chhabra et al conducted a 90-day study (with p-chloroaniline) and found that methemoglobin formation and accompanying hemolytic anemia, extra-medullary hematopoiesis, and splenomegaly were indicative of erythrocyte toxicity and regenerative anemia.

• Methemoglobinemia will stay in history thanks to the famous painting of The Blue People of Kentucky, by Walt Spitzmiller in 1982.

• The following are a few famous cases of methemoglobinemia:

• The ‘blue men of Lurgan’ were a pair of Lurgan men suffering from what was described as ‘familial idiopathic methemoglobinemia‘ who were treated by Dr. James Deeny in 1942. Deeny, who would later become the Chief Medical Officer of the Republic of Ireland, prescribed a course of ascorbic acid and sodium bicarbonate. In case one, by the eighth day of treatment there was a marked change in appearance and by the twelfth day of treatment the patient’s complexion was normal. In case two, the patient’s complexion reached normality over a month-long duration of treatment.

• The Fugates, a family that lived in the hills of Kentucky, are the most famous example of this hereditary chromosomal error. Known as the Blue Fugates, Martin Fugate, settled near Hazard, Kentucky, circa 1800. His wife was a carrier of the recessive methemoglobinemia gene, as was a nearby clan with whom the Fugates intermarried. As a result, many descendants of the Fugates were born with methemoglobinemia.

Reference to these cases is found in the British Medical Journal, June 12, Vol. 1 ,pg. 721, written by J. Deeny, E.T. Murdock and J.J. Rogan and appears also in the book of essays, The End of an Epidemic, by James Deeny ISBN I 899047 06 9. Template:WH Template:WS