Syndrome d’entérocolite médicamenteuse induite par la ropivacaïne injectée par voie péri-nerveuse : premier cas rapporté

Rare cases of drug-induced enterocolitis syndrome have been reported with drugs administered by the oral (amoxicillin, pantoprazole) and intrarectal (paracetamol) routes. No cases have been described by injectable route. Diagnostic criteria, close to those of food protein-induced enterocolitis syndrome, have been proposed in 2019. We report the case of a 72-year-old patient scheduled for a total knee arthroplasty and recused on two occasions after rapid occurrence of drug-induced enterocolitis after peri-nervous injection of ropivacaine during a nerve block carried out before the surgery. Skin tests performed after the first reaction, according to EEACI/ENDA (European Academy of Allergy and Clinical Immunology) recommendations, were negative. The drug provocation test with ropivacaine was also negative. However, the symptoms recurred at the second anesthesia. A few cases of IgE-mediated hypersensitivity to local anesthetics have been reported, but, to our knowledge, this is the first case of drug-induced enterocolitis syndrome induced by an injectable drug, ropivacaine, recurring although skin tests and provocation test resulted negative.