The acquired form of methemoglobinemia may be induced by medication overdose following ingestion, skin absorption, and inhalation [
4]. Drugs may oxidize the hemoglobin directly or indirectly by producing superoxide free radicals [
4]. Route of administration, prolonged use, body surface area, age, accompanying use of oxidative drugs, comorbidity, and high doses of oxidizing drugs are related to the occurrence and severity of methemoglobinemia [
4]. A methemoglobin level up to 15% of total hemoglobin is asymptomatic in healthy patients; headache and fatigue is associated with a level ranging from 15% to 30%; dizziness, dyspnea, and syncope occur at levels of 30–50%; and at levels higher than 50%, central nervous system (CNS) depression, coma, and death are expected [
2,
7]. Symptoms may be worsened due to cardiovascular, hematologic, and pulmonary disorders, as well as infection and renal or liver failure [
4]. Prilocaine, lidocaine, and benzocaine are anesthetics that may cause methemoglobinemia [
8]. In the current case, the excessive use of topical benzocaine and lidocaine resulted in methemoglobinemia presenting with dizziness, cyanosis, and generalized weakness. Nappe
et al. reported a case of methemoglobinemia in a patient who used benzocaine gel three times daily for 3 days [
7]. The gel was self-administered to reduce the toothache [
7]. One study conducted by Hahn
et al. demonstrated that the use of five tubes of EMLA cream (lidocaine and prilocaine) before laser epilation resulted in methemoglobinemia [
9]. Furthermore, Lavergne
et al. [
10] presented a case of methemoglobinemia and acute hemolysis induced by tetracaine lozenges. Several studies reported methemoglobinemia induced by inhalation of anesthetics [
11,
12]. Methemoglobinemia is diagnosed by pulse oximetry, patient symptoms, and ABG with CO-oximetry [
7]. Oxygen saturation gap between SaO
2 measured in ABG and SpO
2 predicts methemoglobinemia [
7]. In calculating SaO
2, all the hemoglobin is assumed normal, whereas SpO
2 shows the percentage of oxyhemoglobin compared with the total hemoglobin [
7]. In this regard, methylene blue and ascorbic acid are used to treat hyperoxia [
2]. Methylene blue, which is not used in hemolysis and G6PD deficiency, oxidized the nicotinamide adenine dinucleotide phosphate (NADPH) and reduced to leukomethylene blue, which turns methemoglobin to hemoglobin [
7]. Ascorbic acid acts directly as an electron donor and reduces methemoglobin to hemoglobin [
2]. Considering the strengths of the current study, in this case acquired methemoglobinemia was accompanied with hemolysis, which was not detected in previous studies and is more likely to be noticed in patients presenting with methemoglobinemia. At first, due to cultural concerns, the patient avoided letting us know about the genital warts, and this could have deviated us from the correct diagnosis; thus, cultural differences should be observed.