Acute hemolytic anemia in a 34-year-old man after inhalation of a volatile nitrite “popper” product

Inhaled nitrites have been used recreationally for centuries,particularly among men who have sex with men (MSM).^([1])After inhalation,this substance quickly enters the blood;within seconds,it can produce a temporary sense of warmth and pleasure,and relax the anal sphincter to relieve the pain of anal sex.^([2,3])“Popper”and“rush”are slang terms given to drugs of the chemical class called amyl nitrite or isobutyl nitrite.Nitrites oxidize hemoglobin to methemoglobins and may increase proteolytic susceptibility of hemoglobin,leading to oxidative hemolysis.Thus,their use is associated with methemoglobinemia and hemolytic anemia,^([4])although nitrite-induced hemolytic anemia has been described only in rare cases (supplementary Table 1).^([4-9])Herein,we report a case of acute hemolytic anemia associated with the use of amyl nitrite.