Methylene Blue Treatment in Refractory Shock Following Chemotherapy: A Case Report

Refractory shock is a life-threatening condition characterized by persistent hypotension and tissue hypoperfusion despite adequate fluid resuscitation and high-dose vasopressors. It frequently progresses to multiorgan failure and has a high mortality rate. We report the case of a 68-year-old male with metastatic prostate adenocarcinoma who developed refractory shock shortly after receiving docetaxel chemotherapy. Despite maximal vasopressor and steroid therapy, the patient remained hypotensive with rising lactate levels. Administration of methylene blue (MB) resulted in rapid hemodynamic improvement, normalization of lactate, and recovery of renal and respiratory function. This case highlights the potential role of MB as an adjunct in managing vasoplegic shock unresponsive to standard therapies.