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. 2017 Oct-Dec;24(5):1073274817729070.
doi: 10.1177/1073274817729070.

Serotonin Syndrome Complicating Treatment of Ifosfamide Neurotoxicity With Methylene Blue

Matthew Snyder  1 , Suhas Gangadhara  2 , Andrew S Brohl  3 , Steven Ludlow  1 , Sowmya Nanjappa  4
Affiliations

Serotonin Syndrome Complicating Treatment of Ifosfamide Neurotoxicity With Methylene Blue

Matthew Snyder et al. Cancer Control. 2017 Oct-Dec.

Abstract

Methylene blue is a widely used treatment for ifosfamide neurotoxicity. We present a case of severe encephalopathy complicating ifosfamide-based therapy for recurrent retroperitoneal leiomyosarcoma. After treatment with methylene blue, the patient experienced clinical decompensation and was diagnosed with serotonin syndrome based on a constellation of clinical findings. Withdrawal of methylene blue and other serotonergic medications led to clinical stabilization and ultimately neurological recovery. Our case highlights the challenge of diagnosing serotonin syndrome in the face of preexisting ifosfamide neurotoxicity, as there is significant clinical overlap between these 2 syndromes. Practitioners must remain vigilant of this potential life-threatening complication in this vulnerable population.

Keywords: ifosfamide neurotoxicity; methylene blue; serotonin syndrome.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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References

    1. Patel PN. Methylene blue for management of ifosfamide-induced encephalopathy. Ann Pharmacother. 2006;40(2):299–303. - PubMed
    1. Lo Y, Shen LJ, Chen WH, Dong YH, Wu FL. Risk factors of ifosfamide-related encephalopathy in adult patients with cancer: a retrospective analysis. J Formos Med Assoc. 2016;115(9):744–751. - PubMed
    1. Sweiss KI, Beri R, Shord SS. Encephalopathy after high-dose ifosfamide: a retrospective cohort study and review of the literature. Drug Saf. 2008;31(11):989–996. - PubMed
    1. Ajithkumar T, Parkinson C, Shamshad F, Murray P. Ifosfamide encephalopathy. Clin Oncol (R Coll Radiol). 2007;19(2):108–114. - PubMed
    1. Gillman PK. CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity. J Psychopharmacol. 2011;25(3):429–436. - PubMed

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