Severe Allergic Drug Reaction to Ultrasound Enhancing Agent Resulting in Cardiogenic Shock

Ultrasound enhancing agents (UEAs) are a commonly used tool to enhance the diagnostic quality of echocardiographic studies. Although serious allergic reactions are rare, they have been documented.

A 39-year-old woman with NYHA functional class I heart failure developed a severe allergic reaction to UEA with decompensation into Society for Cardiovascular Angiography & Interventions stage D cardiogenic shock. Serial echocardiography demonstrated abrupt decrease in left ventricular ejection fraction from a baseline of 45% to 20%, which recovered to 35% before discharge.

Higher rates of adverse drug reactions (ADRs) are reported in observational studies of contemporary practice compared with previously published data. Cardiogenic shock as a consequence of an anaphylactic reaction to Lumason has not been previously described in the literature.

Observational data have shown that ADR to UEA has become more prevalent in the past several years, with higher rates with Lumason vs Definity. It is important to monitor patients who have ADRs to UEA and who are treated with epinephrine, especially those with underlying cardiomyopathy, as there is potential for a transition from anaphylaxis to stress cardiomyopathy and cardiogenic shock. Given the risk for significant ADR, UEA should be used selectively and only as needed.