Methylene Blue Treatment in Refractory Shock Following Chemotherapy: A Case Report

TL;DR

A patient with prostate cancer developed severe shock after chemotherapy, but improved rapidly after treatment with methylene blue.

Contribution

This case report suggests methylene blue may be an effective treatment for refractory vasoplegic shock.

Findings

Methylene blue led to rapid hemodynamic improvement in a patient with refractory shock.

The patient's lactate levels normalized and renal and respiratory function recovered after methylene blue treatment.

Abstract

Refractory shock is a life-threatening condition characterized by persistent hypotension and tissue hypoperfusion despite adequate fluid resuscitation and high-dose vasopressors. It frequently progresses to multiorgan failure and has a high mortality rate. We report the case of a 68-year-old male with metastatic prostate adenocarcinoma who developed refractory shock shortly after receiving docetaxel chemotherapy. Despite maximal vasopressor and steroid therapy, the patient remained hypotensive with rising lactate levels. Administration of methylene blue (MB) resulted in rapid hemodynamic improvement, normalization of lactate, and recovery of renal and respiratory function. This case highlights the potential role of MB as an adjunct in managing vasoplegic shock unresponsive to standard therapies.