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Washington University Experience | MISCELLANEOUS | Methylene Blue Treatment | 1A0 Case 1 History
Case 1 History ---- This patient was a 47 year old female with a past medical history of asthma, morbid obesity, and was non-ambulatory since Dec 2019 following right ankle fracture. In March 2021 she presented to an outside hospital with palpitations, chest pain, shortness of breath, abdominal distention, nausea, and vomiting and was found to have right heart failure, atrial fibrillation with rapid ventricular rate, bilateral pleural effusions, ascites, hyperthyroidism, and acute kidney injury. Her workup included a transthoracic echocardiogram which showed right ventricular dysfunction and signs of pressure overload. Bilateral thoracenteses showed transudative effusions. A CT was concerning for cirrhosis. She was placed on CRRT and required pressors. She also required intubation for epistaxis in the setting of warfarin and had an EGD which showed nonbleeding ulcers. She received a 7 day course of antibiotics for E. faecalis spontaneous bacterial peritonitis. Over her hospital course she developed worsening mental status. She was transferred to BJH for Hepatology consult on 4/27. On arrival, she coded and received three doses of epinephrine and was intubated. Return of spontaneous circulation was achieved and she was transferred to the SICU where she remained hemodynamically unstable, on pressors and methylene blue drip, with worsening metabolic and respiratory acidosis, multiorgan failure, and anemia requiring transfusion. She expired on 5/1, with 4 days of intravenous MB.
