title: Turquoise to dark green organs at autopsy.
abstract: We report the case of a 72-year-old man who died in septic shock following pancreatectomy. At autopsy, organs were discoloured with a rapid colour change from turquoise to dark green, especially of the myocardium. The patient had received 200 mg methylene blue (MB), i.v., for treatment of septic shock 90 min prior to death. Analysis of tissue samples by liquid extraction and liquid chromatography coupled to tandem mass spectrometry demonstrated different concentrations of MB and its metabolites azure A and B in the heart, lungs, kidneys, and liver. Our findings clearly demonstrate the relation of MB administration and organ discolouration at autopsy and shed a new light on MB distribution and accumulation in septic shock.
authors.affiliation: Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany. arne.warth@med.uni-heidelberg.de
authors.forename: Arne
authors.initials: A
authors.lastname: Warth
authors.forename: Benjamin
authors.initials: B
authors.lastname: Goeppert
authors.forename: Christian
authors.initials: C
authors.lastname: Bopp
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Christa
authors.initials: C
authors.lastname: Flechtenmacher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Burhenne
mesh_terms: D000368:Aged; D001344:Autopsy; D002851:Chromatography, High Pressure Liquid; D003327:Coronary Disease / Q000150:complications; D003924:Diabetes Mellitus, Type 2; D004791:Enzyme Inhibitors / Q000378:metabolism* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008751:Methylene Blue / Q000378:metabolism* / Q000627:therapeutic use; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy; D020181:Sleep Apnea, Obstructive / Q000150:complications; D014018:Tissue Distribution
chemical_list: D004791:Enzyme Inhibitors; D008751:Methylene Blue