# Acquired Methemoglobinemia Leading to Death After Fungicide Ingestion: A Case Report

## TL;DR

A patient died after ingesting a fungicide that caused severe methemoglobinemia, a condition where the blood can't carry oxygen properly.

## Contribution

This case highlights the importance of early diagnosis and treatment of methemoglobinemia after fungicide exposure.

## Key findings

- The patient had 80% methemoglobin in the blood after fungicide ingestion.
- Initial treatments like methylene blue and ascorbic acid were ineffective, requiring plasma exchange.
- Early recognition of symptoms is critical for managing this life-threatening condition.

## Abstract

We described a patient who presented with ingestion of fungicide "Perfect Azole," which contains 7.1% azoxystrobin and 11.9% propiconazole. The methemoglobin (MetHb) level was found to be 80% in the blood. Cyanosis, which was not responding to supplemental oxygen, chocolate-brown blood, and an oxygen saturation gap of >5% raised the suspicion of methemoglobinemia. Initially, the patient was treated with the injection of methylene blue (MB) and ascorbic acid. Later, due to persistent MetHb levels, plasma exchange and exchange transfusion were done.

Early suspicion of this condition based on history and non-resolving hypoxia with oxygen and classic color on blood sampling can lead to timely management, which is of paramount importance for this life-threatening condition.