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Abstract

Ifosfamide is a commonly used chemotherapeutic agent indicated for a variety of malignancies; however, given its well-documented complications including Ifosfamide induced encephalopathy (IFE), its overall use is limited. Neurotoxicity secondary to ifosfamide can range from mild confusion to severe neurologic deterioration, with the primary treatment being focused on supportive care. This clinical case highlights a 41-year-old patient with BRAF positive ameloblastic carcinoma who developed acute neurotoxic symptoms following ifosfamide chemotherapy induction. His symptoms, ranging from altered mental status, restlessness, severe headache, and peripheral neuropathy, began shortly after chemotherapy initiation. Both his lab work and imaging could not explain the acute decline. Given his aggressive malignancy, adjunctive treatment necessitated use of intravenous methylene blue, which led to a significant improvement in his clinical encephalopathic symptoms. This case demonstrates the potential role that methylene blue can have as an effective adjunctive therapy in the management of IFE, especially in such cases where chemotherapy continuation is highly recommended. Further investigation is needed to better define more precise dosing and efficacy across the varying degrees of IFE.

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