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World J Crit Care Med. Sep 9, 2026; 15(3): 120702
Published online Sep 9, 2026. doi: 10.5492/wjccm.120702
Published online Sep 9, 2026. doi: 10.5492/wjccm.120702
Methylene blue for treating toxic encephalopathy due to acute nickel poisoning: A case report
Rajathadri Hosur Ravikumar, Department of Critical Care Medicine, Ramaiah Medical College, Bangalore 560054, Karnātaka, India
Sayan Nath, Department of Critical Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge 698797, Cambridgeshire, United Kingdom
Javed Ahsan Quadri, Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Sulagna Bhattacharjee, Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Author contributions: Hosur Ravikumar R, Nath S, and Bhattacharjee S designed the research study, performed the literature search and drafted the manuscript; Quadri JA edited the manuscript and performed the literature search; all authors have read and approved the final manuscript.
AI contribution statement: The authors used the AI model Gemini (Google) for the purpose of language editing and grammatical refinement to ensure the clarity and professional tone of the manuscript. The AI tool was also utilized to help structure the chronological timeline and reorganize clinical data into a systematic narrative format. All clinical observations, diagnostic logic, toxicological data analysis, and the resulting clinical hypotheses were independently developed by the authors. The authors have reviewed, verified, and assume full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of the final manuscript and all submitted materials.
Informed consent statement: Written informed consent was obtained from the patient’s husband (legal next-of-kin) for the publication of this case report and any accompanying images, as the patient was initially unable to provide consent due to her clinical condition.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Rajathadri Hosur Ravikumar, Assistant Professor, Department of Critical Care Medicine, Ramaiah Medical College, M S Ramaiah Nagar, Mathikere, Bengaluru, Bangalore 560054, Karnātaka, India. drrajathadri@gmail.com
Received: March 6, 2026
Revised: May 24, 2026
Accepted: June 23, 2026
Published online: September 9, 2026
Processing time: 169 Days and 0.2 Hours
Revised: May 24, 2026
Accepted: June 23, 2026
Published online: September 9, 2026
Processing time: 169 Days and 0.2 Hours
Core Tip
Core Tip: Standard therapies failed to treat atypical cholinergic toxidrome and refractory vasoplegic shock caused by the ingestion of routine toilet cleaner. An exhaustive toxicology screen revealed acute nickel poisoning, accompanied by central nervous system metal sequestration and a unique cytotoxic lesion of the corpus callosum revealed by brain magnetic resonance imaging. Remarkably, rescue therapy with methylene blue for the shock correlated with a paradoxical spike in urinary nickel excretion and rapid clinical recovery. While the biochemical washout mechanism remains hypothetical, this case offers a crucial clinical framework for managing rare heavy metal toxicity when standard chelators are unavailable.