SHM Converge Scientific Abstract ePoster Gallery-Medicating Chemo-Induced Confusion With Methylene Blue

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This case report describes ifosfamide-induced encephalopathy, a recognized complication of ifosfamide chemotherapy that occurs in about 10–15% of patients. The authors emphasize that this diagnosis should be considered when a patient develops acute altered mental status after receiving ifosfamide, especially after other common causes of encephalopathy have been excluded.<br /><br />The case involves a 54-year-old woman with stage IV endometrial stromal sarcoma who developed waxing and waning confusion on day 3 of her third ifosfamide infusion. She had no focal neurologic deficits, and workup for other causes was unrevealing: CT head and chest X-ray were normal, blood and urine cultures were negative, EEG showed no epileptiform activity, and imaging/labs suggested metastatic liver involvement with elevated ammonia and liver tests.<br /><br />The standard management for ifosfamide encephalopathy is stopping ifosfamide and providing hydration. In this case, methylene blue (MB) was also used as treatment. The report notes that prior studies have used MB at 50 mg IV every 4–6 hours. After MB was started, the patient improved gradually: by 48–60 hours she was more alert and intermittently oriented, by 72–84 hours she had notable improvement but still had brief delirium, and by 96 hours her mental status returned to baseline.<br /><br />The authors conclude that timely methylene blue administration may shorten recovery time in suspected ifosfamide-induced encephalopathy. They also note that maintaining the dosing schedule can be challenging, and missed or delayed doses may prolong recovery.

Asset Subtitle

Kenny Tang

Meta Tag

Author List Arash Shifteh, Kenny Tang, Uzoamaka Aniagba

Category Clinical Vignettes

Concept Ifosfamide-induced encephalopathy

Concept Methylene Blue

Concept Altered Mental Status

Concept Hydration

Concept Discontinuation of ifosfamide

Distinguished Non-Finalist

Presenter Organization Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Presenting Author Kenny Tang

Track Adult

Keywords

ifosfamide-induced encephalopathy

ifosfamide chemotherapy

altered mental status

methylene blue

endometrial stromal sarcoma

confusion

delirium

hyperammonemia

liver metastasis

case report

Ifosfamide-induced encephalopathy

Methylene Blue

Altered Mental Status

Hydration

Discontinuation of ifosfamide