A Rare Case of Cephalosporin Anaphylaxis-Induced Reverse Takotsubo

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Anaphylactic reactions typically present with hypotension and bronchospasm.
• Reverse takotsubo cardiomyopathy (rTTC) is a rare but serious cardiac complication.
• Cefazolin is a commonly used antibiotic, often administered during surgical procedures.

Observation:

• A patient developed cefazolin-induced anaphylaxis during elective shoulder surgery.
• Following anaphylaxis, the patient exhibited symptoms consistent with rTTC.
• Cardiac assessment revealed a significant drop in ejection fraction (EF) from >50% to 32%.

Findings:

• Reverse takotsubo cardiomyopathy (rTTC) was diagnosed in the context of cefazolin anaphylaxis.
• The patient's cardiac function significantly improved, with EF returning to normal within three weeks.
• Standard heart failure management protocols were implemented and effective.

Implications:

• This case underscores the importance of recognizing cardiac manifestations of anaphylaxis beyond typical symptoms.
• Enhanced awareness of rTTC as a potential sequela of antibiotic-induced anaphylaxis is crucial for clinicians.
• Sharing such unusual presentations aids in refining diagnostic and management strategies for anaphylaxis-related cardiac events.