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Washington University Experience | MISCELLANEOUS | Methylene Blue Treatment | 3A0 Case 3 History
Case 3 History ---- The patient was a 72-year-old woman with a past medical history significant for COPD, hypertension, type 2 diabetes mellitus, prior Escherichia coli bacteremia, and aortic and iliac aneurysms status post endovascular repair. She presented to the emergency department with low blood pressure at home. On EMS arrival, she was found to be tachycardic and profoundly hypotensive (blood pressure 60/40 mm Hg) and was started on intravenous fluids en route. Initial evaluation revealed leukocytosis, acute kidney injury, transaminitis, hypoglycemia, mild thrombocytopenia, and elevated lactate. She was treated with intravenous fluids, broad-spectrum antibiotics (cefepime and vancomycin), and vasopressor support with norepinephrine. She was admitted to the intensive care unit in shock requiring escalating vasopressor support. Her clinical course was marked by rapid deterioration with development of acute hypoxic respiratory failure requiring intubation, refractory shock necessitating multiple vasopressors and adjunctive therapies one of which was methylene blue, acute renal failure requiring planned continuous renal replacement therapy, and disseminated intravascular coagulation with associated coagulopathy and thrombocytopenia. Despite broad antimicrobial coverage and aggressive supportive measures, no definitive infectious source was identified. Her condition progressed to refractory multiorgan failure with worsening lactic acidosis and hemodynamic instability. After continued clinical decline despite maximal support, she developed cardiac standstill and was pronounced deceased. Methylene blue is an off-label treatment for severe shock and chemotherapy side effects.
