Turquoise Discoloration of Organs on Autopsy Secondary to Treatment of Septic Shock With Methylene Blue

Septic shock can result from the dissemination of infections and can lead to hypoperfusion secondary to vasodilation. Methylene blue can help stabilize blood pressure refractory to other measures in shock. We report a case of a 58-year-old male who died of septic shock due to Pseudomonas aeroginosa bacteremia secondary to acute folliculitis and epididymo-orchitis. He was given methylene blue for reversal of septic shock but he did not respond and expired. Autopsy findings were significant for bluish-green discoloration of organs, especially the heart, lungs, and brain during prosection secondary to methylene blue treatment. It is important to recognize artifacts of treatment and to discern them from changes due to putrefaction or the classic green pigmentation associated with Pseudomonas aeruginosa infection, such as chloronychia. The case report illustrates that circulating methylene blue and its metabolites can accumulate in the organs in a dose-related fashion, imparting an interesting turquoise to dark blue-green pigment during the autopsy. Additional studies are warranted to enable pathologists to differentiate among the pigmentation associated with Pseudomonas aeruginosa bacteremia, putrefaction, and methylene blue treatment.