SHM Converge Scientific Abstract ePoster Gallery-Blue's Clues: An Interesting Case of Methylene Blue-Induced Serotonin Syndrome

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This case report describes a 38-year-old woman who developed life-threatening serotonin syndrome after an IV methylene blue infusion given off-label to treat vasculitis-related symptoms. She had a history of c-ANCA vasculitis, migraines, anxiety, hypothyroidism, and POTS, and was taking serotonergic medications including amitriptyline and as-needed sumatriptan (though not recently used).<br /><br />Two hours after her fifth methylene blue infusion, which had recently been dose increased, she developed severe vomiting, fever, chills, dizziness, and inability to tolerate oral intake. In the emergency department, she was febrile to 40.3°C, tachycardic, and hypotensive. Infectious and abdominal workup was negative, including CBC, chemistries, cultures, viral testing, chest X-ray, and CT abdomen. The only notable lab abnormality was an elevated ESR.<br /><br />Because infection seemed unlikely, clinicians suspected serotonin syndrome due to methylene blue interaction with serotonergic drugs. She improved rapidly with supportive care, including IV fluids and stopping serotonergic agents. By the next morning, her vitals and labs normalized.<br /><br />The report emphasizes that methylene blue, although used diagnostically and therapeutically in some settings, can precipitate serotonin syndrome, especially in patients taking SSRIs, tricyclic antidepressants, or triptans. The authors caution providers to obtain thorough medication histories and carefully assess drug interactions before giving methylene blue infusions, particularly in patients with autoimmune disease who may already be using migraine medications.

Asset Subtitle

Michelle M. Galindez

Meta Tag

Author List Akash Parashar, Ashwin Gowda, Emma Studlack, Manasik Abdu, Michelle M. Galindez

Category Clinical Vignettes

Concept Methylene Blue

Concept Serotonin Syndrome

Concept Serotonergic Medication

Concept Medication History

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization Brown University Health

Presenting Author Michelle M. Galindez

Track Adult

Keywords

serotonin syndrome

methylene blue

vasculitis

serotonergic drugs

amitriptyline

sumatriptan

drug interaction

fever

supportive care

autoimmune disease

Methylene Blue

Serotonin Syndrome

Serotonergic Medication

Medication History

Drug Discontinuation