Methemoglobinemia is a potentially fatal condition, mainly acquired after intoxication by certain drugs. To this date, only three cases associated with paracetamol have been reported. This case report describes a patient with autosomal dominant polycystic kidney disease undergoing hemodialysis who was self-medicated with acetaminophen for seven days (at a daily dose of 3 g); the patient went to the hospital after noticing the appearance of a diffuse brownish skin tone, without other symptoms. Arterial blood analysis revealed an increase in methemoglobin levels, with biochemistry showing an increase in total bilirubin and alanine aminotransferase. Paracetamol was discontinued and on reassessment nine days after the onset of symptoms the patient had a clear improvement in her skin color, with normalization of methemoglobin levels.
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