Catecholamine refractory, vasopressin responsive, anaphylactic shock  a close differential diagnosis for septic shock in a neutropenic patient

Rona Joseph; Shruti Prem

Volume : VI, Issue : X, October - 2017

Catecholamine refractory, vasopressin responsive, anaphylactic shock a close differential diagnosis for septic shock in a neutropenic patient

Rona Joseph, Shruti Prem

Abstract :

We describe a case of catecholamine refractory anaphylactic shock, secondary to the glycopeptide antibiotic teicoplanin mimicking septic shock, which responded to vasopressin in a patient with acute myeloid leukemia (AML) on induction chemotherapy. Teicoplanin injection for suspected gram–positive infection precipitated profound anaphylactic shock in this patient who continued to be hypotensive for 48 hours and did not respond to adrenaline, nor adrenaline or dopamine infusions. Subsequently she was started on vasopressin infusion at low doses which was effective in promptly restoring hemodynamic stability. We conclude that anaphylaxis can rarely be a cause of hypotension in neutropenic patients. Most episodes of anaphylaxis respond to treatment with single doses of epinephrine, however severe anaphylaxis can be associated with cardiovascular collapse that is difficult to manage. Use of vasopressin in this setting can be life–saving.