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

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.