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Case based discussions
Central cyanosis on a psychiatric unit treated at the Salford Royal Hospital
  1. Darren Green1,
  2. Peter Barry2,
  3. Heather D Green2
  1. 1Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
  2. 2North West Lung Centre, University Hospital of South Manchester, Manchester, UK
  1. Correspondence to Dr Heather Diane Green, North West Lung Centre, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK; heatheryoung{at}


We describe a case of acquired methaemoglobinaemia due to frequent use of the ‘legal high’ known as ‘Pink Panthers’. This contains 5,6-Methylenedioxy-2-aminoindane and 2-Aminoindane, both amphetamine analogues with the potential to cause methaemoglobinaemia. Furthermore, the most common ‘cutting agent’ for legal highs in the UK is benzocaine, also known to cause methaemoglobinaemia. Given the increasing prevalence of legal highs, particularly those containing added benzocaine, such presentations may become more common. Furthermore, in one case series, benzocaine gel used for toothache was the second most common reason for hospitalisation due to acquired methaemoglobinaemia after dapsone use. Indeed, the Federal Drug Agency has issued as public warning as to the risk of these products. We therefore think that clinicians and the public should be made more aware of the risk associated with such agents.

  • Clinical Epidemiology
  • Drug Reactions

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