Camrelizumab-induced anaphylactic shock in an esophageal squamous cell carcinoma patient:A case report and review of literature

BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually increasing.Anaphylactic shock due to camrelizumab has not been reported previously,until now.We report here,for the first time,a case of anaphylactic shock associated with camrelizumab in a patient with esophageal squamous cell carcinoma.CASE SUMMARY An 84-year-old male esophageal cancer patient received radiotherapy and chemotherapy 11 years ago.He was diagnosed with advanced esophageal squamous cell carcinoma with liver metastasis(Tx N1 M1)and received the first immunotherapy(camrelizumab 200 mg/each time,once every 3 wk)dose in December 2020,with no adverse reactions.Three weeks later,a generalized rash was noted on the chest and upper limbs;palpitations and breathing difficulties with a sense of dying occurred 10 min after the patient had been administered with the second camrelizumab therapy.Electrocardiograph monitoring revealed a 70 beats/min pulse rate,69/24 mm Hg(1 mm Hg=0.133 k Pa)blood pressure,28 breaths/min respiratory rate,and 86%pulse oximetry in room air.The patient was diagnosed with anaphylactic shock and was managed with intravenous fluid,adrenaline,dexamethasone sodium phosphate,calcium glucosate,and noradrenaline.Approximately 2 h after treatment,the patient’s anaphylactic shock symptoms had been completely relieved.CONCLUSION Due to the widespread use of camrelizumab,attention should be paid to anti-programmed cell death 1 antibody therapy-associated hypersensitivity or anaphylactic shock.

Atezolizumab-induced anaphylactic shock in a patient with hepatocellular carcinoma undergoing immunotherapy:A case report

BACKGROUND Atezolizumab is a programmed death ligand 1(PD-L1)inhibitor,and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma(HCC).Treatment with immune checkpoint inhibitors(ICIs)can lead to hypersensitivity reactions;however,anaphylactic shock is rare.We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review.CASE SUMMARY A 75-year-old man was diagnosed with HCC recurrence after hepatectomy.He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1(PD-1)inhibitor.The patient showed a sudden onset of dizziness,numbness,and lack of consciousness with severe hypotension during atezolizumab infusion.The treatment was stopped immediately.The patient’s symptoms resolved after 5 mg dexamethasone was administered.Because of repeated hypersensitivity reactions to ICIs,treatment was changed to oral targeted regorafenib therapy.CONCLUSION Further research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.

Successful prolonged cardiopulmonary resuscitation after intraoperative cardiac arrest due to povidone-iodine allergy: A case report

BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk of cardiac arrest.CASE SUMMARY We present a case in which a patient with postoperative infection went into anaphylactic shock and cardiac arrest caused by povidone-iodine during secondary surgery.The patient was successfully resuscitated by 2 h of cardiopulmonary resuscitation.CONCLUSION This is the first known case of cardiac arrest caused by povidone-iodine allergy.

Identification and characterization of the causative triatomine bugs of anaphylactic shock in Zhanjiang,China

Background:Two health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces,and allergic reactions induced by triatomine bites.In the Southwestern United States,reduviid bugs bites commonly cause insect allergy.In South China,four cases of anaphylactic shock have been reported after this bite exposure.To further classify the species of these bugs and confirm the sensitization of the triatomine saliva,we caught triatomine bugs from the region where the bites occurred and performed phylogenetic and immunohistochemical(IHC)analysis.Methods:Triatomine bugs were collected in Donghai Island of Zhanjiang City in South China.The genomic DNA was extracted from three legs of the bugs.The fragments of mitochondrial 16S rRNA,cytochrome c oxidase subunit I(COI)gene and nuclear ribosomal 18S and 28S rRNA genes were obtained by PCR and sequenced.A phylogenetic tree was constructed based on the sequence of 16S rRNA gene using a maximum likelihood method with MEGA 7.0 software.Trypanosomal specific fragments and vertebrate COI genes were amplified from the fecal DNA to detect the infection of trypanosomes and analyze the blood feeding patterns,respectively.Paraffin-embedded sections were then prepared from adult triatomines and sent for IHC staining.Results:We collected two adult triatomine bugs in Donghai Island.Morphological and molecular analyses indicated that the triatomines were Triatoma rubrofasciata.No fragments of T.cruzi or other trypanosomes were detected from the fecal DNA.Mitochondrial gene segments of Homo sapiens and Mus musculus were successfully amplified.The allergens which induced specific IgE antibodies in human serum were localized in the triatomine saliva by IHC assay.Conclusions:The two triatomine bugs from Donghai Island were T.rubrofasciata.They had bitten humans and mice.Their saliva should contain the allergens related to the allergic symptoms and even anaphylactic shock of exposed residents.Great consideration should be given to this triatomine bugs due to their considerable distribution and potential threat to public health in South China.

Study on the anaphylactic shock induced by hemocoagulase for injection based on logistic analysis

In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the adverse reactions induced by hemocoagulase for injection were collected in Chinese and foreign literatures. The clinical characteristics and influencing factors of anaphylactic shock induced by hemocoagulase for injection were evaluated by logistic regression analysis. In this study, 87 articles including 108 cases(68 cases of anaphylactic shock) were collected. Univariate logistic regression indicated that allergic constitution, daily dose, combined anesthesia, first drug delivery, post-dose time and course of treatment were positively associated with the incidence of anaphylactic shock caused by hemocoagulase for injection(P<0.05). The six above-mentioned factors were included in the multivariate logistic stepwise regression analysis to exclude the effects of confounding factors, and the results suggested that allergic constitution(P = 0.048, OR = 8.242), combined anesthesia(P = 0.024, OR = 22.675) and post-dose time(P = 0.006, OR = 20.255) were associated with the incidence of anaphylactic shock caused by hemocoagulase for injection. The clinicians should pay much more attention to risk factors that may cause anaphylactic shock, such as allergic constitution, combined anesthesia and post-dose time. The clinical pharmacists should strengthen pharmaceutical monitoring and improve the safety of medication.