Three-day unrecognized cefazolin anaphylaxis in a case undergoing coronary bypass graft surgery

Cephalosporin anaphylaxis is rare but the diagnosis is usually not delayed when the catastrophic reaction occurs shortly after cephalosporin injection. The authors wish to report a patient who had never had a history of beta-lactam hypersensitivity and developed the first episode of cefazolin anaphylaxis during coronary artery bypass surgery. Hypotension developed during the operation but it was immediately corrected by volume infusion and inotrope administration. Shaking chills, drenching sweats, and tingling sensation on the head developed when she regained consciousness from general anesthesia. The adverse reaction disappeared soon and was thought to be the side effects of anesthetic drugs, morphine administrations, and/or blood transfusion. Similar reactions, together with hypotension and oxygen desaturation, recurred each time cefazolin was infused but it took three days and doses of 12 grams of cefazolin administration before a correct diagnosis was reached. The present case report would remind surgeons and anesthesiologists of cefazolin as a potential cause of anaphylaxis during peri- and post-operative periods.