A coma and a blue remedy: electroencephalographic fingerprint of a treatable toxicity

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Key Points

To illustrate the electroencephalographic changes in a patient with suspected ifosfamide-induced encephalopathy and the response to methylene blue treatment.
Reported a case of a 65-year-old woman with diffuse large B-cell lymphoma experiencing coma after chemotherapy (ICE regimen).
Conducted EEG and serum neuron-specific enolase assessments before and after administering methylene blue (100 mg every 12 h) for 6 days.
Monitored clinical improvement and neurological status post-treatment.
Serum neuron-specific enolase (NSE) elevated to 38.7 μg/L at presentation normalized to 10.0 μg/L by 72 h post-treatment.
EEG showed unreactive burst-attenuation with GPDs on initiation, transitioning to continuous unreactive theta-delta activity after treatment.
The patient experienced complete neurological recovery and extubation by day 3.

Case report shows that methylene blue improves neurological recovery in a patient with ifosfamide toxicity, indicating its therapeutic potential.

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Fisch et al. (2026) studied this question.

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