Afzal Anoshia, Quinton Michael, Farooque Umar, Magguilli Michael
Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Neurology, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Sep 13;12(9):e10434. doi: 10.7759/cureus.10434.
Septic shock can result from the dissemination of infections and can lead to hypoperfusion secondary to vasodilation. Methylene blue can help stabilize blood pressure refractory to other measures in shock. We report a case of a 58-year-old male who died of septic shock due to bacteremia secondary to acute folliculitis and epididymo-orchitis. He was given methylene blue for reversal of septic shock but he did not respond and expired. Autopsy findings were significant for bluish-green discoloration of organs, especially the heart, lungs, and brain during prosection secondary to methylene blue treatment. It is important to recognize artifacts of treatment and to discern them from changes due to putrefaction or the classic green pigmentation associated with infection, such as chloronychia. The case report illustrates that circulating methylene blue and its metabolites can accumulate in the organs in a dose-related fashion, imparting an interesting turquoise to dark blue-green pigment during the autopsy. Additional studies are warranted to enable pathologists to differentiate among the pigmentation associated with bacteremia, putrefaction, and methylene blue treatment.
感染性休克可由感染播散引起，并可导致继发于血管扩张的灌注不足。亚甲蓝有助于稳定对休克的其他治疗措施无效的血压。我们报告一例58岁男性患者，其因急性毛囊炎和附睾炎继发菌血症死于感染性休克。给予他亚甲蓝以逆转感染性休克，但他没有反应并死亡。尸检结果显示，由于亚甲蓝治疗，在尸检过程中器官出现蓝绿色变色，尤其是心脏、肺和脑。认识治疗造成的假象并将其与腐败或与感染相关的典型绿色色素沉着（如绿甲）所导致的变化区分开来很重要。该病例报告表明，循环中的亚甲蓝及其代谢产物可呈剂量相关方式在器官中蓄积，在尸检期间呈现出从有趣的青绿色到深蓝色绿色的色素沉着。有必要进行更多研究，以使病理学家能够区分与菌血症、腐败和亚甲蓝治疗相关的色素沉着。
