Chemical Pneumonitis Due to the Aspiration of Gastric Content Following Anaphylaxis-Related Vomiting

Abstract

Vomiting associated with anaphylaxis may lead to the aspiration of gastric contents with subsequent development of chemical pneumonitis. In cases with large volumes of aspiration, respiratory failure may develop. There are some differences of chemical pneumonitis from aspiration pneumonia like rapid development of respiratory failure and clinical and radiological recovery within a short time. We present this case because it is a rare and important case of gastric content aspiration during an anaphylactic reaction with subsequent development of chemical pneumonitis. Anaphylactic reaction was developed in a 26-year old female after intravenous injection of sultamicilline and metamizole. The patient vomited during the reaction leading to the aspiration of the gastric contents. She had dyspnea and low oxygen saturation at presentation to our emergency unit. She was cyanotic, sweaty, dyspneic and tachypneic. She was transferred to the intensive care unit on the basis of possible need for ventilation support. Her chest radiography showed bilateral basal infiltrations, more pronounced on the right side. With oxygen therapy, respiratory exercise, agents to ease expectoration, and postural drainage oxygen saturation was obtained to be 90%. No further invasive procedures (bronchoscopy, etc.) were deemed necessary due to rapid clinical improvement. A good radiological response was obtained on the first day. A possibility of vomiting during anaphylaxis should be borne in mind and measures should be taken to prevent gastric aspiration whenever possible. The aspiration of gastric contents may lead to severe clinical course including respiratory failure, therefore close monitoring of the patient is necessary. Also, it should be remembered that clinical presentation, treatment and complications are different in chemical pneumonitis from aspiration pneumonia.