A case report of fatal anaphylaxis on first exposure to rasburicase just before lymphoma treatment.

IF 2.6 4区医学 Q2 ALLERGY

Allergy Asthma and Clinical Immunology Pub Date : 2024-10-26 DOI:10.1186/s13223-024-00920-9

Yoshikazu Utsu, Natsuho Kaneda, Makio Kawakami, Shin-Ichi Masuda, Hironori Arai, Sonoko Shimoji, Rena Matsumoto, Takafumi Tsushima, Kazusuke Tanaka, Kosuke Matsuo, Chiharu Kimeda, Shiho Konno, Nobuyuki Aotsuka

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Abstract

Background: Rasburicase, a recombinant urate oxidase enzyme, has potent efficacy in controlling uric acid and is widely used to prevent tumor lysis syndrome in high-risk patients owing to its low toxicity profile. However, it has been associated with a risk of anaphylaxis, especially on re-exposure, owing to its immunogenic potential.

Case presentation: A 71-year-old Japanese female diagnosed with diffuse large B cell lymphoma with a large tumor burden experienced anaphylactic shock leading to death upon initial administration of rasburicase. The pre-and postmortem examination revealed that the cause of death was a cascade of events starting with anaphylaxis-induced distributive shock leading to obstructive shock due to the collapse of the heart, which was compressed by the post-mediastinal tumor. This was further compounded by massive bleeding from the tumor and tension hemothorax, resulting in circulatory collapse.

Conclusions: Although extremely rare, rasburicase can cause fatal anaphylaxis, even on first exposure.

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淋巴瘤治疗前首次接触拉斯布酶导致致命性过敏性休克的病例报告。

背景：重组尿酸氧化酶（Rasburicase）具有控制尿酸的强大功效，由于其毒性低，被广泛用于预防高危患者的肿瘤溶解综合征。然而，由于其潜在的免疫原性，它与过敏性休克的风险有关，特别是在再次接触时：病例介绍：一名 71 岁的日本女性被诊断患有弥漫性大 B 细胞淋巴瘤，肿瘤体积较大，在首次使用拉斯布酶时出现过敏性休克并导致死亡。死前和死后检查显示，死亡原因是一连串的事件，首先是过敏性休克引起的分布性休克，然后是心脏衰竭导致的梗阻性休克，而心脏衰竭是由纵隔后肿瘤压迫造成的。肿瘤的大量出血和张力性血气胸进一步加重了病情，导致循环衰竭：结论：尽管拉布卡酶极为罕见，但即使首次接触也可引起致命的过敏性休克。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Allergy Asthma and Clinical Immunology ALLERGY-IMMUNOLOGY

CiteScore

4.30

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： Allergy, Asthma & Clinical Immunology (AACI), the official journal of the Canadian Society of Allergy and Clinical Immunology (CSACI), is an open access journal that encompasses all aspects of diagnosis, epidemiology, prevention and treatment of allergic and immunologic disease. By offering a high-visibility forum for new insights and discussions, AACI provides a platform for the dissemination of allergy and clinical immunology research and reviews amongst allergists, pulmonologists, immunologists and other physicians, healthcare workers, medical students and the public worldwide. AACI reports on basic research and clinically applied studies in the following areas and other related topics: asthma and occupational lung disease, rhinoconjunctivitis and rhinosinusitis, drug hypersensitivity, allergic skin diseases, urticaria and angioedema, venom hypersensitivity, anaphylaxis and food allergy, immunotherapy, immune modulators and biologics, immune deficiency and autoimmunity, T cell and B cell functions, regulatory T cells, natural killer cells, mast cell and eosinophil functions, complement abnormalities.