Successful Management of a Lung Transplant Patient With an Anaphylactic Reaction to Methylprednisolone Sodium Succinate: A Case Report

Abstract

Background

Methylprednisolone sodium succinate (MPS) is one of the key immunosuppressive drugs in the management of patients undergoing solid organ transplantation, and is known to rarely induce anaphylaxis. Several case reports describe an anaphylactic reaction to MPS in kidney and liver transplant patients; however, there have been no reports of an anaphylactic reaction to MPS in a lung transplant patient.

Case report

A female patient was diagnosed with mixed connective tissue disease and Sjögren’s syndrome when she was 10 years old. When the patient was 19 years old, she developed interstitial pneumonia, which gradually worsened despite treatment with oral prednisolone, mycophenolate mofetil, and tacrolimus. Therefore, lung transplantation was planned. The patient had previously developed an anaphylactic reaction when being administered steroid pulse therapy using MPS, while no other drugs had induced any allergic reaction. Therefore, a drug provocation test was performed to identify suitable alternative steroids to MPS before lung transplantation. Dexamethasone was shown to be safe and was thus administered during a lung transplant operation and the early postoperative period. The dexamethasone was then switched to oral prednisolone, and the patient was discharged approximately one month after the operation without having had any anaphylactic reactions to dexamethasone and oral prednisolone and without experiencing allograft rejection.

Conclusion

This case underscores the importance of using dexamethasone and oral prednisolone as an alternative therapeutic approach in the management of lung transplant recipients with an anaphylactic reaction to MPS.