Three-Day Unrecognized Cefazolin Anaphylaxis in
a Case Undergoing Coronary Bypass Graft Surgery
Varut Lohsiriwat MD, PhD*, Somchai Sriyoscharti MD*,
Manee Raksakietisak MD**, Amorn Leelarasamee MD***
Affiliation :
* Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Cephalosporin anaphylaxis is rare but the diagnosis is usually not delayed when the catastrophic reaction occurs
shortly after cephalosporin injection. The authors wish to report a patient who had never had a history of beta-lactam
hypersensitivity and developed the fi rst episode of cefazolin anaphylaxis during coronary artery bypass surgery. Hypotension
developed during the operation but it was immediately corrected by volume infusion and inotrope administration. Shaking
chills, drenching sweats, and tingling sensation on the head developed when she regained consciousness from general
anesthesia. The adverse reaction disappeared soon and was thought to be the side effects of anesthetic drugs, morphine
administrations, and/or blood transfusion. Similar reactions, together with hypotension and oxygen desaturation, recurred
each time cefazolin was infused but it took three days and doses of 12 grams of cefazolin administration before a correct
diagnosis was reached. The present case report would remind surgeons and anesthesiologists of cefazolin as a potential
cause of anaphylaxis during peri- and post-operative periods.
Keywords : drug allergy, anaphylaxis, type I hypersensitivity, cefazolin, cephalosporins, misdiagnosis
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