Levofloxacin-induced anaphylactic shock and rhabdomyolysis
10.3760/cma.j.cn114015-20201204-01210
- VernacularTitle:左氧氟沙星致过敏性休克诱发横纹肌溶解症
- Author:
Lirui SUN
1
;
Wei ZHOU
1
;
Xu TIAN
1
;
Hongmei ZHANG
1
;
Qiushi GUO
1
Author Information
1. 吉林大学第一医院二部药学部，长春 130031
- Publication Type:Journal Article
- Keywords:
Levofloxacin;
Anaphylaxis;
Rhabdomyolysis;
Acute kidney injury
- From:
Adverse Drug Reactions Journal
2021;23(6):332-334
- CountryChina
- Language:Chinese
-
Abstract:
A 42-year-old male patient, who suffered serious wound pollution due to falling after drinking, received an intravenous infusion of levofloxacin hydrochloride injection 0.2 g dissolved in 0.9% sodium chloride injection 250 ml to prevent infection. When the first dose of levofloxacin was infused intravenously for about 2 minutes (about 4 ml), the patient suddenly developed dyspnea, restlessness, and agitation. His heart rate was 120 beats per minute, breath rate was 26 times per minute, blood pressure was undetectable, and blood oxygen saturation was 0.80. Levofloxacin was immediately discontinued and antiallergic therapy such as epinephrine and dexamethasone was given. Two minutes later, the patient′s heart rate dropped to 50 beats per minute, breathing decreased to 8 times per minute, and cyanotic appeared on the skin. Anaphylactic shock and type 2 respiratory failure were diagnosed and cardiopulmonary resuscitation, tracheal intubation, balloon assisted ventilation, and norepinephrine etc. were given immediately. Three hours later, the patient developed dark urine and elevated creatine kinase (CK), myoglobin, alanine aminotransferase, aspartate aminotransferase, and serum creatinine (Scr). His peak value of CK was 17 160 U/L, myoglobin was >3 000 μg/L, and peak value of Scr was 492 μmol/L. Rhabdomyolysis with acute kidney injury was considered. The symptomatic and supportive treatments such as hemofiltration, plasma infusion, correction of acidosis, and fluid replacement were given. Ten hours later, the patient′s blood pressure returned to normal, ventilator assisted breathing was continued, and the patient′s condition was gradually improved. Thirty-four days later, the levels of myoglobin, CK and Scr returned to within the normal range. Thirty-eight days later, the patient returned to spontaneous breathing and the ventilator was withdrawn.
