Aniline-induced refractory
methemoglobinemia
in polytrauma: successful management
with erythrocytapheresis

Aniline-induced refractory
methemoglobinemia
in polytrauma: successful management
with erythrocytapheresis

Methemoglobinemia, Tissue hypoxia, Erythrocytapheresis, Methylene blue, Aniline dyes, Polytrauma

Abstract
Background Methemoglobinemia is a life-threatening condition characterized by the inability of hemoglobin to
transport oxygen efficiently. This case report describes acquired methemoglobinemia caused by exposure to aniline
dye, which was successfully treated with erythrocytapheresis following the insufficient effect of methylene blue.
Case presentation A 39-year-old male suffered multiple injuries, including burns and fractures, after falling into
a barrel containing aniline. On site, emergency medical services (EMS) intubated the patient, performed chest
decompression for pneumothorax, and decontaminated him before transferring him to a trauma centre. In the
emergency unit, imaging revealed multiple rib, scapula, and pelvic fractures, retroperitoneal bleeding, and 15% total
body surface area (TBS) burns. He was hemodynamically unstable, with metabolic acidosis, an oxygen saturation
gap, and an initial methemoglobin level (MetHb) of 19%. Despite methylene blue treatment, the MetHb levels rose
to undetectable levels (>20%), and severe hemodynamic instability, refractory hypoxia, and metabolic derangement
required the use of erythrocytapheresis.
Conclusion Aniline exposure leads to the oxidation of ferrous iron (Fe2+) in hemoglobin to ferric iron (Fe3+),
resulting in methemoglobinemia and impaired oxygen delivery. While methylene blue remains the first-line
treatment, erythrocytapheresis proved effective in restoring tissue oxygenation in refractory methemoglobinemia
complicated by hemorrhagic and traumatic shock.
Keywords Methemoglobinemia, Tissue hypoxia, Erythrocytapheresis, Methylene blue, Aniline dyes, Polytrauma

Karolína Lečbychová1,2, Marcela Káňová1,3*, Paula Dzurňáková1,2, Šárka Blahutová5

, Tereza Romanová2,3,4 and

Denis Buršík1,4,6

https://doi.org/10.1186/s12245-025-01026-8

2025

Peri Irawan

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