title: Phototoxic reaction after parathyroid surgery: case report and review of the literature.
abstract: BACKGROUND
  A woman of 41 years old underwent surgery for primary hyperparathyroidism. She developed a long-lasting sharply demarcated erythematous skin reaction, appearing one hour after parathyroid surgery. This erythematous reaction felt like sunburn and was limited to the light exposed skin of the operation field, leading to the diagnosis of a phototoxic reaction. Since this phototoxic reaction occurred just after changing the operation lamp from a halogen type to a Light-Emitting Diode (LED) type, we suspected that the type of operation lamp could be a part of the cause of this phototoxic reaction. This is because our department has never before diagnosed phototoxic reactions (with a halogen type of operation lamp) during methylene blue (MB) assisted parathyroid surgery.
  
  
  METHODS
  To investigate the cause of this phototoxic reaction, we performed an analysis of the adverse effects of all administered peroperative drugs and an evaluation of altered operation conditions.
  
  
  RESULTS
  MB, used as a peroperative surgical marker of the parathyroid glands, was the most likely causal agent of this phototoxic reaction. Emission spectrum analysis of the operation light shows that the new LED operation lamp gives a high intensity of blue light. This may have resulted in activation of MB leading to a phototoxic reaction.
  
  
  CONCLUSIONS
  To our knowledge, this is the first described phototoxic reaction in adults due to MB used as peroperative marker. Although rare, this potential side effect should be considered when using high doses of MB in combination with high intensity of blue light.
authors: Faculty of Medicine and Healt Sciences, Ghent University Hospital, Belgium.
authors: P
authors: P
authors: Lambrecht
authors: G
authors: G
authors: Vandeplas
authors: S
authors: S
authors: Van Slycke
authors: P F
authors: PF
authors: Smet
authors: N
authors: N
authors: Brusselaers
authors: H
authors: H
authors: Vermeersch
mesh_terms: D000328:Adult; D017484:Dermatitis, Phototoxic / Q000209:etiology*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008029:Lighting / Q000009:adverse effects*; D008751:Methylene Blue / Q000009:adverse effects*; D009873:Operating Rooms
chemical_list: D008751:Methylene Blue