Authors: Gazzè G, et al.
A & A Practice 19(7): e02010, July 2025. doi:10.1213/XAA.0000000000002010
This case report describes a rare adverse reaction to Patent Blue V (PBV), a dye commonly used for lymph node mapping and now increasingly applied in lymphatic reconstruction. A 60-year-old woman undergoing breast reconstruction developed widespread bluish skin discoloration, blue–green urine, mild oxygen desaturation, and methemoglobinemia after receiving a 50-mg intradermal bolus of PBV. While PBV is generally considered safe, this represents the first report of diffuse bluish skin discoloration as a clinical manifestation.
What You Should Know:
PBV can cause clinically significant side effects, including hypoxemia misreadings on pulse oximetry and methemoglobinemia. Diffuse bluish skin discoloration is a novel presentation and could complicate diagnosis or monitoring. Clinicians using PBV should maintain awareness of these risks, carefully monitor oxygenation, and be prepared to manage methemoglobinemia.
Clinical Relevance:
For anesthesiologists, awareness of PBV’s potential to confound SpO₂ readings and induce methemoglobinemia is critical in perioperative monitoring. If unexplained desaturation or cyanosis occurs after dye administration, PBV toxicity should be considered. Preparedness to treat methemoglobinemia, including availability of methylene blue, is important in centers where PBV is used.
References
Authors: Barthelmes L, et al.
Breast 19(6):512–515, 2010. doi:10.1016/j.breast.2010.05.003
Authors: Patten DK, et al.
BMJ Case Rep 2011;2011:bcr0320114033. doi:10.1136/bcr.03.2011.4033
Authors: Vasilopoulos T, et al.
Anesth Analg 120(1):41–49, 2015. doi:10.1213/ANE.0000000000000479
Thank you to A & A Practice for allowing us to use this article.