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Refractory anaphylactic shock associated with ketoconazole treatment
Ping-Yen Liu1, Cheng-Han Lee, Li-Jen Lin
1Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center; Institute of Clinical Medicine, National Cheng-Kung University, No. 138 Sheng-Li Road, Tainan 704, Taiwan. larry@mail.ncku.edu.tw
The Annals of Pharmacotherapy
|February 11, 2005
Summary
Ketoconazole can cause severe anaphylactic shock, a rare but serious reaction, even with oral use. This case highlights the importance of monitoring for this adverse event in elderly patients.
Area of Science:
- Pharmacology
- Clinical Medicine
- Toxicology
Background:
- Ketoconazole is an antifungal medication used to treat various fungal infections.
- Anaphylactic shock is a severe, life-threatening allergic reaction.
- Drug-induced anaphylaxis can present with diverse and severe symptoms.
Observation:
- A case report details a 72-year-old woman who developed severe hypotension and refractory anaphylactic shock while on oral ketoconazole for a Candida albicans corneal infection.
- Hemodynamic monitoring revealed a low peripheral vascular resistance with a high cardiac output index, consistent with anaphylactic shock.
- Elevated plasma tryptase levels confirmed the diagnosis of anaphylactic shock.
Findings:
- The patient experienced severe hypotension unresponsive to standard treatments, strongly associated with ketoconazole intake.
- Swan-Ganz catheterization provided crucial hemodynamic data supporting the diagnosis of anaphylactic shock.
- The Naranjo probability scale indicated a probable link between ketoconazole and the adverse event.
Implications:
- This case highlights a previously unreported severe adverse reaction to oral ketoconazole, emphasizing the need for vigilance.
- Early diagnosis and management of drug-induced anaphylaxis are critical, especially in elderly patients.
- Invasive hemodynamic monitoring and biomarker assessment (e.g., tryptase) can aid in diagnosing and managing complex anaphylactic shock cases.