Histological Features of Methylene Blue-Induced Phototoxicity Administered in the Context of Parathyroid Surgery
- Resource Type
- Authors
- Lucy Ostlere; Lorrette Ffolkes; Ciara A. Maguire; Manuraj Singh; Venura Samarasinghe; Anup Sharma; Malgorzata Kurzepa; Lida Alarcon
- Source
- The American Journal of dermatopathology. 39(8)
- Subject
- Parathyroidectomy
Adult
Pathology
medicine.medical_specialty
medicine.medical_treatment
Photodynamic therapy
Context (language use)
Dermatology
Pathology and Forensic Medicine
030207 dermatology & venereal diseases
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
medicine
Humans
Coloring Agents
Hyaline
business.industry
Parathyroid neoplasm
General Medicine
Middle Aged
medicine.disease
Methylene Blue
Parathyroid Neoplasms
chemistry
030220 oncology & carcinogenesis
Female
Phototoxicity
business
Bulla (amulet)
Methylene blue
Dermatitis, Phototoxic
- Language
- ISSN
- 1533-0311
Methylene blue is a chromophore dye known for its photosensitizing properties. It is also administered intravenously as a tracer in parathyroid surgery to identify abnormal glands. We describe 2 cases of acute methylene blue-induced phototoxicity in patients who underwent parathyroidectomy. Both patients developed an acute vesiculopustular inflammatory rash on the anterior neck corresponding to the site exposed intraoperatively to overhanging surgical lights. One of the patients also developed a bulla on her finger at the site of attachment of the oxygen probe. Biopsies were taken from both patients at different time points. The histological findings included destruction of sebaceous glands and deposition of diastase-periodic acid-Schiff-positive hyaline material around dermal blood vessels. These features are similar to those seen in skin treated with photodynamic therapy and systemic photosensitivity disorders such as the porphyrias. The wavelengths of light emitted by the surgical lights and oxygen probe overlap with the absorption spectrum of methylene blue. This resulted in excitation of the systemically administered methylene blue at exposed sites, with resultant local tissue damage and a phototoxic reaction.