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Compartment syndrome of the extremities is a rare but potentially devastating condition. We herein report a case of a 53-year old female with an unusual case of hand compartment syndrome and fasciitis secondary to methylene blue (MB) extravasation to detect urinary tract injury intraoperatively. This was recognized immediately and fasciotomy was performed. Features of this case are discussed together with its implications. Despite MB's long history of use, few adverse events of an accidental extravasation have been reported., (© 2023 The Authors.)