Anaphylactic Shock Probably due to a Cross-Reaction Between Cefuroxime and Piperacillin-Presentation of a Fatal Case,...

Area of Science:

• Anesthesiology
• Immunology
• Pathology

Background:

• Beta-lactam antibiotics are common in intensive care but carry a risk of rare, fatal anaphylactic reactions.
• Cross-reactivity between different beta-lactam classes (penicillins, cephalosporins) can precipitate hypersensitivity.
• Perioperative cardiac arrest following antibiotic administration necessitates thorough investigation.

Purpose of the Study:

• To report a fatal case of anaphylaxis following administration of cefuroxime and piperacillin/tazobactam.
• To investigate the potential cross-reactivity or co-sensitization between these beta-lactam antibiotics.
• To emphasize the role of autopsy in diagnosing anaphylaxis in ambiguous clinical scenarios.

Main Methods:

• Case report of a 68-year-old male patient experiencing perioperative cardiac arrest.
• Clinical review of antibiotic administration (cefuroxime, ampicillin/sulbactam, piperacillin/tazobactam) and patient response.
• Autopsy with histopathological examination, including immunohistochemistry for mast cell degranulation.

Main Results:

• The patient suffered cardiovascular arrest after receiving piperacillin/tazobactam, following prior cefuroxime administration.
• Autopsy revealed no macroscopic cause of death, but immunohistochemistry showed mast cell degranulation (starry sky pattern).
• Findings suggest anaphylaxis as the cause of death, potentially due to cross-reactivity or co-sensitization to multiple beta-lactams.

Conclusions:

• This case highlights severe allergic reactions to both cefuroxime and piperacillin/tazobactam.
• Clinicians must be aware of beta-lactam cross-reactivity and co-sensitization risks in allergic patients.
• Consideration of non-beta-lactam alternatives is crucial for high-risk individuals.