Background: Hemolytic anemia is a rare but possible complication of inhaled nitrite use, particularly among patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This occurs when the oxidative effect of nitrites exceeds the enzymatic reducing capacity of the erythrocytes. In patients with G6PD deficiency, this reducing capacity is impaired, making them more susceptible to hemolysis.

Case: A 36-year-old male with no relevant medical history was admitted to the Internal Medicine ward presenting with fever (38 °C), general malaise, and mucocutaneous jaundice. Laboratory tests revealed a non-autoimmune regenerative hemolytic anemia with a hemoglobin of 8.3 g/dL, reticulocytes of 12.8%, unesterified bilirubin of 7.7 mg/dL, LDH of 1590 U/L, haptoglobin <8 mg/dL, and a negative direct Coombs test. Notably, three days before symptom onset, the patient used inhaled nitrites (“Poppers”) recreationally. Further investigation confirmed G6PD deficiency.

Conclusion: Nitrite inhalation can trigger hemolytic anemia in both healthy and G6PD-deficient individuals.