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Intraoperative anaphylaxis to bacitracin during pacemaker change and laser lead extraction
John F Freiler1, Kevin E Steel, Larry L Hagan
1Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA. John.Freiler@lackland.af.mil
Summary
This case report details a severe allergic reaction, anaphylaxis, in a patient undergoing pacemaker surgery due to bacitracin irrigation. It highlights the critical risk of intraoperative anaphylaxis from this common antibiotic.
Area of Science:
- Anesthesiology
- Immunology
- Cardiovascular Surgery
Background:
- Bacitracin is frequently used in surgical settings for wound management and implant preparation.
- Despite its utility, bacitracin is a recognized sensitizer, capable of inducing allergic contact dermatitis and severe anaphylaxis.
Observation:
- A 72-year-old female experienced anaphylaxis following the irrigation and packing of an infected pacemaker pocket with a bacitracin solution.
- Diagnostic workup included skin prick testing to bacitracin and latex, serum tryptase and histamine levels, and cardiac enzyme measurements.
Findings:
- The patient exhibited immediate hypersensitivity reactions to both bacitracin ointment and solution upon skin testing.
- Elevated serum tryptase levels (49 ng/mL) were detected six hours post-event, normalizing the following day.
- Latex allergy was ruled out through negative skin testing and undetectable serum IgE levels.
Implications:
- This report represents the first documented instance of anaphylaxis to bacitracin during pacemaker surgery.
- It underscores the potentially life-threatening nature of intraoperative anaphylaxis induced by bacitracin, necessitating heightened clinical awareness.
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