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Case Reports
. 2017:2017:8747326.
doi: 10.1155/2017/8747326. Epub 2017 Oct 2.

Severe Undifferentiated Vasoplegic Shock Refractory to Vasoactive Agents Treated with Methylene Blue

Farheen Manji  1   2 , Benjamin Wierstra  1   3 , Juan Posadas  1   3
Affiliations
Case Reports

Severe Undifferentiated Vasoplegic Shock Refractory to Vasoactive Agents Treated with Methylene Blue

Farheen Manji et al. Case Rep Crit Care. 2017.

Abstract

Methylene blue is a phenothiazine-related heterocyclic aromatic molecule presently used in the treatment of methemoglobinemia. Recently, it has been implicated in the treatment of severe refractory vasoplegic shock caused by anaphylaxis, sepsis, or postcardiopulmonary bypass. We present a case of a 27-year-old male with profound vasoplegic shock of unknown etiology which was refractory to vasopressors who responded within hours to a single dose of methylene blue. Additionally, we review the evidence of methylene blue's role in the treatment of shock. This case illustrates a diagnostic approach and treatment options in the setting of undifferentiated vasodilatory shock and outlines a new and emerging role for methylene blue in this clinical setting.

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Figures

Figure 1
Figure 1
Vasopressor requirements hours after methylene blue administration.
Figure 2
Figure 2
(a) The biochemical pathway of vasodilatory shock as a result of upregulation of the nitric oxide-cGMP pathway. (b) Methylene blue's site of action, as a guanylyl cyclase inhibitor, resulting in increased vasomotor tone.
See this image and copyright information in PMC

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