A Case of an Intraoperative Iatrogenic Methanol Exposure

Andrew Micciche, Eric Johnson, Breanne Mefford, Amber McCoy, Peter Akpunonu, Mehboob Kalani, Ashish Maskey

Research output: Contribution to journalArticlepeer-review


Objective: Background: Case Report: Conclusions: Diagnostic/therapeutic accidents ThinPrep Cytolyt is a methanol-based cell preservation solution frequently used to fix tissue samples immediately following endobronchial ultrasound-guided fine-needle aspiration. Currently, no published reports de-scribe an iatrogenic exposure to Cytolyt. We report the only known case of an accidental intraoperative administration of a methanol solution, with corresponding plasma concentrations, and successful treatment with fomepizole. A 70-year-old woman with a history of stage IIIA rectal adenocarcinoma was referred for evaluation of a new-ly identified lung mass. During the procedure, a bronchoalveolar lavage (BAL) of the right upper lobe was per-formed. After BAL, the proceduralist was informed that the syringe used to instill fluid for the BAL contained Cytolyt rather than saline. The Department of Medical Toxicology was contacted immediately, and the patient received a 15 mg/kg dose of fomepizole. The first plasma methanol level, before fomepizole administration, was elevated to 21 mg/dL. The methanol level was 13 mg/dL 3 h after fomepizole treatment and even low-er thereafter; therefore, no additional fomepizole was required. The patient did not develop signs of systemic toxicity and was discharged on hospital day 3. Following methanol exposures, patients can exhibit metabolic acidosis, with potential for blindness, hemody-namic instability, and possibly death if untreated. Fomepizole (4-methylpyrazole) inhibits alcohol dehydroge-nase and is a mainstay of treatment. Preventing medical errors is key in ensuring optimal patient care and de-creasing adverse events. Providers using CytoLyt and any similar products should be aware of this potential error and approach the possibility of methanol toxicity as they would other routes of methanol exposure.

Original languageEnglish
Article numbere937247
Pages (from-to)e937247-1-e937247-4
JournalAmerican Journal of Case Reports
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© Am J Case Rep,.


  • Bronchoalveolar Lavage
  • Fomepizole
  • Medication Errors

ASJC Scopus subject areas

  • General Medicine


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