key: cord-0926631-rqc9tj3n
authors: Alvarez-Perea, Alberto; Baeza, María Luisa
title: Anaphylactic shock following diagnosis of COVID-19
date: 2020-08-01
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2020.07.032
sha: 1126b3dfe914227ad782e21cd7b13d09433186de
doc_id: 926631
cord_uid: rqc9tj3n

nan

Authors:

Alberto Alvarez-Perea 1,2 , MD, PhD, María Luisa Baeza, MD, PhD 1,2,3 .

1 A 74-year-old woman with a history of hypertension and bronchial asthma presented to 5 the emergency department with a 3-day history of malaise, subjective fever, dry cough 6 and diarrhea. On admission, temperature was 36.9°C, pulse 99 beats per minute, blood 7 pressure 127/83 mm Hg and oxygen saturation 93% while she was breathing ambient 8 air. Laboratory tests showed mild lymphopenia (lymphocyte count 1.0 × 10 9 /l) and the 9 C-reactive protein level was elevated at 55 mg/l. Chest radiography showed no 10 consolidations. COVID-19 was diagnosed on the basis of RT-PCR testing that detected 11 SARS-CoV-2. Following the hospital's COVID-19 protocol, the patient was discharged 12 with instructions for isolation and cefixime 400 mg daily as empirical antibiotic to 13 prevent potential superinfection. She had tolerated other beta-lactams in the past 14 (penicillin, amoxicillin), but did not recall taking cephalosporins. Cytokine release syndrome has been described in patients with COVID-19, that present 41 with sudden-onset dyspnea, hypoxemia and increased D-dimer levels 2 and a variety of 42 skin lesions which have also been reported 3 , including urticaria 4 . However, these signs 43 and symptoms may also be present in patients with anaphylaxis, including elevated D-44 dimer levels 5 . Therefore, differential diagnosis between these two conditions can be infections are known to act as co-factors, increasing the severity of anaphylaxis 6 . This 51 might have contributed to the severity of anaphylaxis in this particular case. Finally, 52 cefixime allergy could not be confirmed, due to the fatal outcome. However, the 53 temporal sequence strongly suggests that cefixime was the trigger of anaphylaxis 7 . 

Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

Acute urticaria with angioedema in the setting of coronavirus disease 2019

The mast cell, contact, and coagulation system connection in anaphylaxis

Addressing the Epidemic of Antibiotic