Fluconazole administration leading to anaphylactic shock in a preterm newborn

Area of Science:

• Neonatal immunology
• Pharmacology
• Clinical toxicology

Background:

• Preterm infants possess immature innate immunity, reducing their susceptibility to anaphylaxis.
• Fluconazole prophylaxis is administered to very low birth weight infants to prevent invasive candidiasis.
• Adverse effects associated with fluconazole are exceptionally rare.

Observation:

• A male newborn, born at 26 weeks gestation with a birth weight of 900 g, received intravenous fluconazole.
• Following fluconazole administration, the infant exhibited signs of anaphylaxis, including hypotension and an erythematous rash.

Findings:

• This report details the first documented case of fluconazole-induced anaphylaxis in a newborn.
• The adverse reaction manifested as severe hypotension and a widespread rash.

Implications:

• Clinicians must consider anaphylaxis as a potential adverse effect of intravenous fluconazole in neonates.
• Awareness of this rare but potentially fatal reaction is crucial for prompt diagnosis and management in neonatal intensive care units.