Acute cyanotic episode in an infant

Abstract

Methemoglobinemia is a rare cause of cyanosis in paediatric age due to the exposure to haemoglobin-oxidizing agents such as nitrates present in well water or vegetables (spinach, beets, carrots, courgette and green beans).
Methemoglobinemia associated with high-nitrate infant food has been reported frequently. Consumption of vegetable puree with an incorrect storage is a potential cause of acquired infantile methemoglobinemia. Infants younger than 6 months old are particularly susceptible to this condition.
We report a case of a 9-month-old male infant who was brought to the paediatric emergency department with central cyanosis after eating a homemade mixed vegetable puree prepared in advance and stored in the refrigerator longer than 48 hours. His methemoglobin level determined by cooximetry was 12.1%. After 6 hours, the syndrome was completely resolved without needing methylene blue treatment.