Role of Methylene Blue in Refractory Anaphylaxis -A Case Report
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Abstract
Refractory anaphylaxis is defined as anaphylaxis which, after treatment with at least 2 doses of minimum 300 microgram epinephrine, does not achieve normalization of symptoms. Dysregulation of NO synthesis and vascular smooth cell guanylate cyclase activation may have a role in refractory vasoplegia. Methylene blue is competitive inhibitor of NO synthase and guanylate cyclase. Thus, blocking the effects on cGMP mediated smooth muscle relaxation and vasodilation and mast cell mediator release. Thus, methylene blue has been implicated as a treatment option for refractory vasoplegia. We present the case of a 21-year-old male who presented with anaphylactic shock that was unresponsive to epinephrine. After administration of methylene blue, his blood pressure and sensorium improved; and he was gradually extubated. Hence, our clinical experience suggests that methylene blue is a safe treatment option for refractory anaphylactic shock.
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