Unmasking hypotension by beta lactam during dextran sulfate low-density lipoprotein apheresis

The authors report, for the first time, potentially fatal adverse effects of combined treatment using beta lactam and low-density lipoprotein (LDL) apheresis with dextran sulfate adsorption. A 62-year-old man was receiving LDL apheresis because of peripheral artery disease. Cefmetazole was administered to treat infection of a leg ulcer. Although antibiotics alone did not cause any allergic reactions, he manifested circulatory collapse during LDL apheresis. Possible mechanisms for shock were discussed.