[Anaphylactoid shock during intravenous urography. Possible interaction between complement and fibrinolytic systems...

Shock associated with deep coma was induced by an injection of methylglucamine iodotalamate for descending urography to a 56-years old man without any history of atopy. Under intensive care the acute symptoms were controlled, and consciousness returned to a normal level within 15 days, but the patient remained with right-side monoplegia. Biological investigations showed a fall in total haemolytic complement (CH50) and in C1, C4, C2 and C3 components, as well as in B-factor. Acute fibrinolysis and hypocalcaemia were also present. Two main mechanisms seem to be responsible for the accident : intolerance to the drug, with direct activation of the complement and fibrinolytic systems ; and an immuno-allergic reaction where the contrast medium behaved like an hapten, which became antigenic in the body.