{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:22:28Z","timestamp":1783164148855,"version":"3.54.6"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johann Wolfgang Goethe-Universit\u00e4t, Frankfurt am Main"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Unusual findings during an autopsy may come from peculiarities in the position, shape, size, weight, consistency, smell or color of organs. The following study was triggered by an autopsy case in which an unusual blue-green discoloration of organs, which changed during the autopsy, was noticed. A review of the local autopsy database, selected cases including the antemortem clinical documentation and the literature has been performed to clarify the etiology of these conspicuous discolorations and to evaluate their diagnostic value. The study showed that certain xenobiotics may lead to such discoloration. After systemic administration of methylene blue, darkening blue-green discoloration of organs, especially the brain and heart, can be observed. In addition, the systemic administration of toluidine blue also appears to be capable of causing such discoloration. Beyond that, drugs (like Rohypnol<jats:sup>\u00ae<\/jats:sup>) or other foreign substances (like detergents) containing warning colors, i.e. indigocarmin (E132) or Brilliant Blue FCF (E133) may cause discolorations of the upper gastrointestinal tract or the urinary bladder respectively. A blue-green, possibly darkening discoloration of organs during autopsy may point towards an antemortem administration of certain xenobiotics. The affected organs give an indication of the possible route of application and the type of substance. A differentiated interpretation of the etiology of such conspicuous discolorations at autopsy should only be made considering the (medical) history and, if necessary, complementary (toxicological) examinations.<\/jats:p>","DOI":"10.1007\/s12024-024-00903-7","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T11:35:20Z","timestamp":1730288120000},"page":"1060-1068","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fifty shades of green and blue: autopsy findings after administration of xenobiotics"],"prefix":"10.1007","volume":"21","author":[{"given":"J.","family":"Baumgarten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Greb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Holz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Nie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Petzel-Witt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-0624","authenticated-orcid":false,"given":"Christoph G.","family":"Birngruber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"903_CR1","volume-title":"Entwurf Einer pathologisch-anatomischen Prop\u00e4deutik","author":"J Engel","year":"1845","unstructured":"Engel J. Entwurf Einer pathologisch-anatomischen Prop\u00e4deutik. Wien: Kaulfuss, Prandel & Comp.; 1845."},{"key":"903_CR2","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/PAF.0000000000000641","volume":"42","author":"JT Ahrendsen","year":"2021","unstructured":"Ahrendsen JT, Varma H. Green Discoloration of Human Postmortem brains: etiologies and mechanisms of discoloration. Am J Forensic Med Pathol. 2021;42:135\u201340.","journal-title":"Am J Forensic Med Pathol"},{"key":"903_CR3","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s12024-020-00316-2","volume":"17","author":"C Dur\u00e3o","year":"2021","unstructured":"Dur\u00e3o C, Pedrosa F, Dinis-Oliveira RJ. Greenish-blue discoloration of the brain and heart after treatment with methylene blue. Forensic Sci Med Pathol. 2021;17:148\u201351.","journal-title":"Forensic Sci Med Pathol"},{"key":"903_CR4","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00428-009-0734-x","volume":"454","author":"A Warth","year":"2009","unstructured":"Warth A, Goeppert B, Bopp C, Schirmacher P, Flechtenmacher C, Burhenne J. Turquoise to dark green organs at autopsy. Virchows Arch. 2009;454:341\u20134.","journal-title":"Virchows Arch"},{"key":"903_CR5","doi-asserted-by":"publisher","first-page":"150","DOI":"10.23907\/2016.016","volume":"6","author":"LJ Szymanski","year":"2016","unstructured":"Szymanski LJ, Hurth K. Pistachio and Avatar Green-Blue discoloration of the brain. Acad Forensic Pathol. 2016;6:150\u20132.","journal-title":"Acad Forensic Pathol"},{"key":"903_CR6","first-page":"35","volume":"230","author":"A Osterwald","year":"2012","unstructured":"Osterwald A, Scholz J, Gehl A, P\u00fcschel K. Zur Differentialdiagnose: Der Blaue Magen: Postmortale Anf\u00e4rbeversuche Der Magenschleimhaut Mit Methylenblau. Arch Kriminol. 2012;230:35\u201341.","journal-title":"Arch Kriminol"},{"key":"903_CR7","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.legalmed.2007.11.005","volume":"10","author":"M Ago","year":"2008","unstructured":"Ago M, Ago K, Ogata M. Two fatalities by hydrogen sulfide poisoning: variation of pathological and toxicological findings. Leg Med (Tokyo). 2008;10:148\u201352.","journal-title":"Leg Med (Tokyo)"},{"key":"903_CR8","doi-asserted-by":"publisher","first-page":"bcr2013008828","DOI":"10.1136\/bcr-2013-008828","volume":"2013","author":"R Swain","year":"2013","unstructured":"Swain R, Mallick S, Behera C, Murty OP. Bluish discolouration of stomach in dextropropoxyphene poisoning: an unusual finding at autopsy and discussion of differential diagnosis. BMJ Case Rep. 2013;2013:bcr2013008828.","journal-title":"BMJ Case Rep"},{"key":"903_CR9","first-page":"23","volume":"227","author":"H Nadjem","year":"2011","unstructured":"Nadjem H, Perdekamp MG, Auw\u00e4rter V, Stefan P, Thierauf A. Zur Differentialdiagnose Des Blau verf\u00e4rbten Mageninhalts. Arch Kriminol. 2011;227:23\u201332.","journal-title":"Arch Kriminol"},{"key":"903_CR10","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/s001940050096","volume":"9","author":"M Tsokos","year":"1999","unstructured":"Tsokos M. Das F\u00e4rbeverhalten Der Magenschleimhaut Nach Ingestion Von Rohypnol 1 Filmtabletten: Morphologische Befunde Nach Peroraler Aufnahme und experimentelle postmortale Beobachtungen. Rechtsmedizin. 1999;9:138\u201340.","journal-title":"Rechtsmedizin"},{"key":"903_CR11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3109\/10520295.2010.515490","volume":"86","author":"K Krafts","year":"2011","unstructured":"Krafts K, Hempelmann E, Oleksyn B. The color purple: from royalty to laboratory, with apologies to Malachowski. Biotech Histochem. 2011;86:7\u201335.","journal-title":"Biotech Histochem"},{"key":"903_CR12","unstructured":"Guttmann P, Ehrlich P. \u00dcber die Wirkung des Methylenblau bei Malaria. [German]. Berliner Klinische Wochenschrift 1891;28: 953\u20136 [Internet]. [cited 2022 Jan 17]; https:\/\/www.pei.de\/SharedDocs\/Downloads\/DE\/institut\/veroeffentlichungen-von-paul-ehrlich\/1886-1896\/1891-wirkung-methylenblau-malaria.pdf?__blob=publicationFile&v=2"},{"key":"903_CR13","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1179\/135100003225002899","volume":"8","author":"RH Schirmer","year":"2003","unstructured":"Schirmer RH, Coulibaly B, Stich A, Scheiwein M, Merkle H, Eubel J, et al. Methylene blue as an antimalarial agent. Redox Rep. 2003;8:272\u20135.","journal-title":"Redox Rep"},{"key":"903_CR14","doi-asserted-by":"crossref","unstructured":"Schirmer RH, Adler H, Pickhardt M, Mandelkow E. Lest we forget you \u2014 methylene blue\u2026 Neurobiology of Aging. 2011;32:2325.e7-2325.e16.","DOI":"10.1016\/j.neurobiolaging.2010.12.012"},{"key":"903_CR15","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1001\/jama.1933.02740050053028","volume":"100","author":"PJ Hanzlik","year":"1933","unstructured":"Hanzlik PJ. Methylene blue as antidote for cyanide poisoning. JAMA. 1933;100:357.","journal-title":"JAMA"},{"key":"903_CR16","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1056\/NEJM193306012082205","volume":"208","author":"CW Steele","year":"1933","unstructured":"Steele CW, Spink WW. Methylene Blue in the Treatment of Poisonings Associated with Methemoglobinemia. N Engl J Med. 1933;208:1152\u20133.","journal-title":"N Engl J Med"},{"key":"903_CR17","doi-asserted-by":"crossref","unstructured":"Mowry JB, Spyker DA, Cantilena LR, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers\u2019 National Poison Data System (NPDS): 31st Annual Report. Clinical Toxicology. 2014;52:1032\u2013283.","DOI":"10.3109\/15563650.2014.987397"},{"key":"903_CR18","volume-title":"Goldfrank\u2019s toxicologic emergencies. Eleventh edition","year":"2019","unstructured":"Nelson L, editor. Goldfrank\u2019s toxicologic emergencies. Eleventh edition. New York: McGraw-Hill Education; 2019."},{"key":"903_CR19","doi-asserted-by":"publisher","first-page":"3692","DOI":"10.1007\/s12325-020-01422-x","volume":"37","author":"F Puntillo","year":"2020","unstructured":"Puntillo F, Giglio M, Pasqualucci A, Brienza N, Paladini A, Varrassi G. Vasopressor-Sparing Action of Methylene Blue in severe Sepsis and shock: a narrative review. Adv Ther. 2020;37:3692\u2013706.","journal-title":"Adv Ther"},{"key":"903_CR20","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1055\/s-0034-1373685","volume":"45","author":"S Bier","year":"2014","unstructured":"Bier S, Schwentner C. Harnleiterverletzung\u2013 Visualisierung Der Ureteren in Der Abdominalchirurgie. Aktuelle Urol. 2014;45:95\u20136.","journal-title":"Aktuelle Urol"},{"key":"903_CR21","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1055\/s-0043-125318","volume":"49","author":"I Lang","year":"2018","unstructured":"Lang I, Fisch M, Kluth L. Diagnostik Und Therapie vesikovaginaler und ureterovaginaler Fisteln. Aktuel Urol. 2018;49:83\u201391.","journal-title":"Aktuel Urol"},{"key":"903_CR22","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1177\/0310057X0203000606","volume":"30","author":"D Memis","year":"2002","unstructured":"Memis D, Karamanlioglu B, Yuksel M, Gemlik I, Pamukcu Z. The Influence of Methylene Blue Infusion on cytokine levels during severe Sepsis. Anaesth Intensive Care. 2002;30:755\u201362.","journal-title":"Anaesth Intensive Care"},{"key":"903_CR23","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1097\/00003246-200110000-00002","volume":"29","author":"MY Kirov","year":"2001","unstructured":"Kirov MY, Evgenov OV, Evgenov NV, Egorina EM, Sovershaev MA, Sveinbj\u00f8rnsson B, et al. Infusion of methylene blue in human septic shock: a pilot, randomized, controlled study. Crit Care Med. 2001;29:1860\u20137.","journal-title":"Crit Care Med"},{"key":"903_CR24","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1007\/s13181-013-0298-7","volume":"9","author":"DH Jang","year":"2013","unstructured":"Jang DH, Nelson LS, Hoffman RS. Methylene Blue for Distributive Shock: a potential New Use of an old antidote. J Med Toxicol. 2013;9:242\u20139.","journal-title":"J Med Toxicol"},{"key":"903_CR25","doi-asserted-by":"publisher","first-page":"e0142605","DOI":"10.1371\/journal.pone.0142605","volume":"10","author":"A Belletti","year":"2015","unstructured":"Belletti A, Musu M, Silvetti S, Saleh O, Pasin L, Monaco F, et al. Non-adrenergic vasopressors in patients with or at risk for vasodilatory shock. A systematic review and Meta-analysis of Randomized trials. PLoS ONE. 2015;10:e0142605.","journal-title":"PLoS ONE"},{"key":"903_CR26","doi-asserted-by":"publisher","first-page":"e378","DOI":"10.1097\/PCC.0000000000002295","volume":"21","author":"AV Otero Luna","year":"2020","unstructured":"Otero Luna AV, Johnson R, Funaro M, Canarie MF, Pierce RW. Methylene Blue for refractory shock in children: a systematic review and Survey Practice Analysis. Pediatr Crit Care Med. 2020;21:e378.","journal-title":"Pediatr Crit Care Med"},{"key":"903_CR27","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1016\/j.jemermed.2013.08.102","volume":"46","author":"JCY Lo","year":"2014","unstructured":"Lo JCY, Darracq MA, Clark RF. A review of Methylene Blue Treatment for Cardiovascular Collapse. J Emerg Med. 2014;46:670\u20139.","journal-title":"J Emerg Med"},{"key":"903_CR28","doi-asserted-by":"publisher","first-page":"bcr2012007402","DOI":"10.1136\/bcr-2012-007402","volume":"2013","author":"N Aggarwal","year":"2013","unstructured":"Aggarwal N, Kupfer Y, Seneviratne C, Tessler S. Methylene blue reverses recalcitrant shock in \u03b2-blocker and calcium channel blocker overdose. BMJ Case Rep. 2013;2013:bcr2012007402\u20132012007402.","journal-title":"BMJ Case Rep"},{"key":"903_CR29","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00228-008-0563-x","volume":"65","author":"I Walter-Sack","year":"2008","unstructured":"Walter-Sack I, Rengelshausen J, Oberwittler H, Burhenne J, Mueller O, Meissner P, et al. High absolute bioavailability of methylene blue given as an aqueous oral formulation. Eur J Clin Pharmacol. 2008;65:179\u201389.","journal-title":"Eur J Clin Pharmacol"},{"key":"903_CR30","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.carpath.2008.06.012","volume":"19","author":"CD Tan","year":"2010","unstructured":"Tan CD, Rodriguez ER. Blue dye, green heart. Cardiovasc Pathol. 2010;19:125\u20136.","journal-title":"Cardiovasc Pathol"},{"key":"903_CR31","unstructured":"Royal Society of Chemistry. The \u2018blue bottle\u2019 experiment [Internet]. [cited 2024 Jan 10]. https:\/\/edu.rsc.org\/experiments\/the-blue-bottle-experiment\/729.article"},{"key":"903_CR32","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/NEN.0b013e318283d41a","volume":"72","author":"S Lummus","year":"2013","unstructured":"Lummus S, Kleinschmidt-DeMasters BK. Methylene Blue Avatar Brain. J Neuropathol Exp Neurol. 2013;72:263\u20135.","journal-title":"J Neuropathol Exp Neurol"},{"key":"903_CR33","doi-asserted-by":"publisher","first-page":"251","DOI":"10.4103\/0973-029X.99081","volume":"16","author":"G Sridharan","year":"2012","unstructured":"Sridharan G, Shankar A. Toluidine blue: a review of its chemistry and clinical utility. J Oral Maxillofac Pathol. 2012;16:251.","journal-title":"J Oral Maxillofac Pathol"},{"key":"903_CR34","doi-asserted-by":"crossref","unstructured":"Epstein JB, Oakley C, Millner A, Emerton S, van der Meij E, Le N. The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. 1997;83:537\u201347.","DOI":"10.1016\/S1079-2104(97)90117-7"},{"key":"903_CR35","unstructured":"Dr F. K\u00f6hler Chemie GmbH. Gebrauchs- und Fachinformation \u201eToluidinblau R [Internet]. 2016 [cited 2024 Jan 2]. https:\/\/www.koehler-chemie.de\/wp-content\/uploads\/2021\/02\/10500350-Toluidinblau_V11.pdf"},{"key":"903_CR36","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1007\/s12024-021-00417-6","volume":"17","author":"C Berlit","year":"2021","unstructured":"Berlit C, S\u00fctterlin M, Yen K, Wei\u00df C, Heinze S, Tuschy B, et al. Female genital injury\u2014which findings have to be considered physiological using colposcopy with and without toluidine blue dye? Forensic Sci Med Pathol. 2021;17:634\u201342.","journal-title":"Forensic Sci Med Pathol"},{"key":"903_CR37","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1055\/s-0032-1304841","volume":"28","author":"A Schaper","year":"2012","unstructured":"Schaper A, Bandemer G, Callies A, Brau C, Braun J, D\u00f6rges V, et al. Vorhaltung Von Antidota Im Notarztdienst. Notarzt. 2012;28:114\u20138.","journal-title":"Notarzt"}],"container-title":["Forensic Science, Medicine and Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-024-00903-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12024-024-00903-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-024-00903-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T03:17:49Z","timestamp":1759461469000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12024-024-00903-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,30]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["903"],"URL":"https:\/\/doi.org\/10.1007\/s12024-024-00903-7","relation":{},"ISSN":["1556-2891"],"issn-type":[{"value":"1556-2891","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,30]]},"assertion":[{"value":"14 October 2024","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2024","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study has been approved by the local Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare that they have no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}