Cefixime : Anaphylactic shock: case report

Abstract

Author Information An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 74-year-old woman developed anaphylactic shock during treatment with cefixime as an empiric treatment to prevent potential superinfection. The woman, who was diagnosed with coronavirus disease 2019 (COVID-19), started receiving treatment with cefixime 400mg daily [route not stated] as an empirical antibiotic therapy for the prevention of potential superinfection. After few hours, she presented to the emergency department due to sudden onset of dyspnoea. Examination revealed a BP of 90/55mm Hg, pulse rate of 119 beats per minutes and oxygen saturation of 80%. She also reported erythema, hives, systemic pruritus and a swollen tongue. The episode started 20 minutes following the initiation of first cefixime dose and progressed from the initial mild pruritus of her palms and soles. These clinical presentation and findings were consistent with anaphylactic shock. The woman was treated with methylprednisolone, dexchlorpheniramine, salbutamol and oxygen. In two hours, she experienced a full recovery with an improvement of vital signs. However, a cytokine release syndrome was suspected, and she was admitted to the COVID-19 unit. Subsequently, she started receiving off label treatment with hydroxychloroquine and lopinavir/ritonavir. She remained in stable condition until day 12 when her condition suddenly worsened with the reappearance of hypoxemia and fever. Investigation revealed left middle-lobe pneumonia, which was treated with methylprednisolone. Thereafter, she was shifted to the ICU on day 13 due to deterioration of her condition. Despite intubation, anticoagulation and vasoactive drug therapy, she died after 9 days [cause of death not stated].