Abstract

ALMEIDA, José Pedro; LOPES, Anabela; PEDRO, Elisa  and  BARBOSA, Manuel Pereira. A case report of perioperatory hypersensitivity to non-steroidal anti-inflammatory drug. Rev Port Imunoalergologia [online]. 2016, vol.24, n.4, pp.227-233. ISSN 0871-9721.

Background: Several drugs may be responsible for perioperatory allergic reactions. The authors document one case report of IgE-mediated hypersensitivity to a nonsteroidal anti-inflammatory drug in the perioperatory period. Case report: 74 year-old woman, with a past history of blood hypertension and hypotiroidism. This patient has a history of generalized urticaria related to three surgeries. The first reaction (2010) occurred 24h after a knee artroscopy and she was medicated with: bupivacaine, paracoxib, diclofenac, metamizol, esomeprazole, metoclopramide, enoxaparin, cefazolin and diazepam. The second reaction (2012) occurred 8 hours after a cystocele repair and the drugs used were: bupivacaine, sufentanyl, midazolam, cefoxitine, ephedrine, paracetamol, metamizole and insulin. The third reaction (2013) occurred 6 hours after knee prosthesis implantation and the drugs used were: enoxaparin, esomeprazole, captopril, cefazolin, diazepam, levotiroxine, hidroxizine, granisetron, cetorolac, paracetamol, metamizol, tramadol and metoclopramide. The diagnosis workup revealed a positive intradermal test for metamizol, and the patient tolerated other anti-inflammatory drugs. Additionally, due to muscular pain, this patient was mistakenly administered with intravenous metamizol at emergency room, and a reproducible reaction has been observed. Conclusion: This reports a case of metamizol IgE-mediated hypersensitivity in a patient with multiple surgeries and several culprit drugs, which complicated our investigation

Keywords : Drug allergy; metamizol; non-steroidal anti-inflammatory drugs; perioperatory.

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