Abstract
Septic shock is associated with high mortality, particularly in patients who develop refractory vasoplegia despite guideline-directed therapy. Excess nitric oxide mediated vasodilation contributes to catecholamine resistance and persistent hypotension. Methylene blue (MB), an inhibitor of nitric oxide synthase and soluble guanylate cyclase, has emerged as a potential adjunctive therapy targeting this pathway. We report a case of a 36-year-old female presenting with severe septic shock secondary to aspiration pneumonia, complicated by profound hypoxemia requiring mechanical ventilation and veno-venous extracorporeal membrane oxygenation. Despite aggressive fluid resuscitation, broad-spectrum antibiotics, corticosteroids, and maximal vasopressor support, she remained hemodynamically unstable. Administration of intravenous MB resulted in rapid improvement in mean arterial pressure and facilitated weaning of vasopressors within 72 hours. The patient subsequently improved clinically and was discharged in stable condition. Emerging evidence suggests that MB improves hemodynamic parameters and reduces vasopressor requirements in refractory septic shock, although its effect on mortality remains uncertain. This case highlights the potential role of MB as a rescue therapy in vasoplegic shock and underscores the need for larger randomized studies to define its optimal use.
Recommended Citation
Naqvi, MD, Warda; Lowery, DO, Paulina; Haddad, MD, Enad; Ali, MD, Muneeba; Sevella, MD, Prerana; Nugooru, MD, Sudeep; and Friedenheim, MD, Richard
(2026)
"Methylene Blue as an Adjunctive Therapy in Refractory Septic Shock: A Case-Based Review of Emerging Evidence,"
The Medicine Forum: Vol. 27, Article 33.
Available at:
https://jdc.jefferson.edu/tmf/vol27/iss1/33
