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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Methylene blue for the treatment of refractory septic shock secondary to listeriosis in a paediatric patient
  1. Jesús Angel Domínguez-Rojas1,2,
  2. Patrick Caqui3,
  3. Abel Sanchez3 and
  4. Alvaro J Coronado Munoz4
  1. 1 Deparment of Pediatrics, National Hospital Edgardo Rebagliati Martins, Lima, Peru
  2. 2 Deparment of Critical Care, Instituto Nacional De Salud Del Niño Breña, Lima, Peru
  3. 3 Department of Pediatrics, Hospital Nacional Hipolito Unanue, Lima, Peru
  4. 4 Deparment of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  1. Correspondence to Dr Alvaro J Coronado Munoz; alvaro.j.coronadomunoz{at}uth.tmc.edu

Abstract

Current therapies frequently used for refractory septic shock include hydrocortisone, vasopressin, extracorporeal membrane oxygenation (ECMO) support, inodilators, levosimendan and methylene blue. The evidence for these treatments is very limited. We present a case of a 5-year-old patient with refractory septic shock, secondary to Listeria monocytogenes meningitis. She presented with status epilepticus and developed septic shock. Shock persisted despite multiple high-dose vasoactive medications. ECMO support was not available. The medical team decided to use methylene blue to revert the vasoplegia, with excellent results. Shortly after the administration, vasopressors were weaned off and the high lactate cleared. She developed severe neurological sequelae due to brain haemorrhage secondary to the Listeria meningitis. The evidence supporting methylene blue for refractory septic shock in paediatric patients is limited. This case represents the effectiveness of this therapy without secondary effects.

  • meningitis
  • paediatric intensive care
  • cardiovascular system
  • paediatrics (drugs and medicines)

https://doi.org/10.1136/bcr-2021-243772

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    Footnotes

    • Twitter @ajcoronadom

    • Contributors All authors contributed equally to the writing, editing and preparation of the manuscript. JAD-R, PC and AS conducted the reporting, acquired the data. JAD-R, PC, AS and AJCM discuss planning and conceptualised manuscript. JAD-R created the graphic in figure 2. AJCM critically reviewed and edited the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.