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Case 6: Skin Discoloration, Methemoglobinemia, and Acute Interstitial Nephritis in a 15-year-old Girl

Mihir R. Atreya, Najla Al Jaberi, Donna. J. Claes and Oded Volovelsky
Pediatrics in Review August 2017, 38 (8) 389; DOI: https://doi.org/10.1542/pir.2016-0238
Mihir R. Atreya
*Department of Pediatrics and
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Najla Al Jaberi
*Department of Pediatrics and
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Donna. J. Claes
†Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Oded Volovelsky
†Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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  1. Mihir R. Atreya, MD, MPH*
  2. Najla Al Jaberi, MD*
  3. Donna. J. Claes, MD, MS, BS Pharm†
  4. Oded Volovelsky, MD, PhD†
  1. *Department of Pediatrics and
  2. †Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
  • AUTHOR DISCLOSURE

    Drs Atreya, Al Jaberi, Claes, and Volovelsky have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 15-year-old girl who has a history of recurrent urinary tract infections (UTIs) presents to the emergency department with a 3-day history of decreased urine output, nausea, vomiting, shortness of breath, and concerns about appearing yellow. She reports that 1 month ago she was treated for a UTI with a 10-day course of trimethoprim-sulfamethoxazole. Because of persistent urinary pain, she has taken phenazopyridine for the past 7 days (200 mg 3 times daily).

On initial physical examination, she has a temperature of 97.8°F (36.6°C), heart rate of 94 beats/min, respiratory rate of 24 breaths/min, blood pressure of 112/78 mm Hg, and reassuring capillary refill. The only other finding of note is a yellowish-orange discoloration of her skin. Pulse oximetry reveals an Spo2 of 87%, which does not improve with supplemental oxygen. Arterial oxygen saturation is normal and venous co-oximetry reveals methemoglobinemia (methemoglobin value of 18.5% [0.18]; normal range: 0.5%-1.5% [0.01-0.01]). Urine microscopy shows large white blood cells and trace bacteria. Blood chemistry documents a marked elevation of serum creatinine to 2.92 …

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Pediatrics in Review: 38 (8)
Pediatrics in Review
Vol. 38, Issue 8
1 Aug 2017
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Case 6: Skin Discoloration, Methemoglobinemia, and Acute Interstitial Nephritis in a 15-year-old Girl
Mihir R. Atreya, Najla Al Jaberi, Donna. J. Claes, Oded Volovelsky
Pediatrics in Review Aug 2017, 38 (8) 389; DOI: 10.1542/pir.2016-0238

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Case 6: Skin Discoloration, Methemoglobinemia, and Acute Interstitial Nephritis in a 15-year-old Girl
Mihir R. Atreya, Najla Al Jaberi, Donna. J. Claes, Oded Volovelsky
Pediatrics in Review Aug 2017, 38 (8) 389; DOI: 10.1542/pir.2016-0238
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