Case Report Open Access 15 Methaemoglobinaemia is a rare but potentially life -threatening cause of hypoxemia that may be overlooked in emergency settings. We report a case of acquired methaemoglobinaemia in a 36 - year-old man following inhalation of an alkyl nitrite –containing recreational product (“Super Rush ”). The patient presented with cyanosis and hypoxemia on pulse oximetry despite minimal symptoms and preserved arterial oxygen tension. Diagnosis was confirmed by co -oximetry demonstrating elevated methaemoglobin levels. Prompt treatment with intravenous methylene blue led to rapid clinical and biochemical improvement. This case highlights the importance of suspecting and recognising recreational inhalants as a cause of methaemoglobinaemia and the utility of co -oximetry in patients with unexplained cyanosis and a saturation gap

Eczema herpeticum (EH), a life -threatening viral infection complicating atopic dermatitis, is rarely reported in adults with erythroderma. We present a 58-year-old male with untreated, severe atopic dermatitis who developed EH, manifesting as generalised erythroderma, monomorphic vesicles, and systemic symptoms with fever, hypertension. Diagnosis was confirmed by Tzanck smear, HSV-1 PCR, and bacterial culture revealing Staphylococcus aureus. Resource limitations necessitated oral acyclovir which achieved resolution of vesicles and fever within eight days. Concurrent management included intravenous vancomycin for bacterial superinfection, topical therapies, and cyclosporine for recalcitrant atopic dermatitis. Hypertension, a relative contraindication to cyclosporine, was controlled with nifedipine, enabling safe immunosuppression. By day 13, skin lesions normalised, pruritus resolved, and blood pressure stabilised. This case underscores oral acyclovir ’s efficacy in resource-limited settings and highlights multidisciplinary strategies for managing EH with comorbidities like hypertension. Early antiviral intervention, tailored antimicrobial therapy, and vigilant monitoring remain critical to optimising outcomes in severe EH-atopic dermatitis overlap.