Tribuddharat Sirirat, Sathitkarnmanee Thepakorn, Kitkhuandee Amnat, Theerapongpakdee Sunchai, Ngamsaengsirisup Kriangsak, Chanthawong Sarinya
Department of Anesthesiology, Khon Kaen University, Khon Kaen, Thailand.
Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Drug Healthc Patient Saf. 2016 Feb 9;8:9-12. doi: 10.2147/DHPS.S91514. eCollection 2016.
Cefazolin is commonly administered before surgery as a prophylactic antibiotic. Hypersensitivity to cefazolin is not uncommon, and the symptoms mostly include urticaria, skin reaction, diarrhea, vomiting, and transient neutropenia, which are rarely life threatening. We present a rare case of fatal cefazolin hypersensitivity in a female who was diagnosed with multiple meningiomas and scheduled for craniotomy and tumor removal. Immediately after cefazolin IV administration, the patient developed acute hypertensive crisis, which resolved within 10 minutes after the treatment. This was followed by unexplained metabolic acidosis. The patient then developed severe brain edema 100 minutes later. The patient had facial edema when her face was exposed for the next 30 minutes. A computed tomography scan revealed global brain edema with herniation. She was admitted to the intensive care unit for symptomatic treatment and died 10 days after surgery from multiorgan failure. The serum IgE level was very high (734 IU/mL). Single-dose administration of cefazolin for surgical prophylaxis may lead to rare, fatal adverse reaction. The warning signs are sudden, unexplained metabolic acidosis, hypertensive crisis, tachycardia, and facial angioedema predominating with or without cutaneous symptoms like urticaria.
头孢唑林通常在手术前作为预防性抗生素使用。对头孢唑林过敏并不罕见，症状主要包括荨麻疹、皮肤反应、腹泻、呕吐和短暂性中性粒细胞减少，这些症状很少危及生命。我们报告一例罕见的女性头孢唑林过敏致死病例，该女性被诊断为多发性脑膜瘤，计划进行开颅手术和肿瘤切除。静脉注射头孢唑林后，患者立即出现急性高血压危象，治疗后10分钟内缓解。随后出现不明原因的代谢性酸中毒。100分钟后患者出现严重脑水肿。接下来的30分钟，当患者面部暴露时出现面部水肿。计算机断层扫描显示全脑水肿伴脑疝形成。她被收入重症监护病房进行对症治疗，术后10天因多器官衰竭死亡。血清IgE水平非常高（734 IU/mL）。单剂量使用头孢唑林进行手术预防可能会导致罕见的致命不良反应。警示症状为突然出现的不明原因的代谢性酸中毒、高血压危象、心动过速以及以面部血管性水肿为主，伴有或不伴有荨麻疹等皮肤症状。
