Case highlights rare, life-threatening reaction to common antibiotic
Rapid emergency care saves new mother from severe allergic angioedema
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The case of a new mother who developed severe acute allergic angioedema triggered by a common antibiotic was described by researchers in India in a new report, with the team seeking to stress the importance of early and “aggressive” treatment of reactions to even routinely used drugs.
The woman, in her late 30s, delivered her baby successfully and ultimately made a full recovery. But the researchers stressed the need for vigilance during surgical procedures whenever there are signs of angioedema, which broadly refers to swelling in the deeper layers of the skin or in mucous membranes.
“This case underscores the unpredictable nature of severe [antibiotic] allergies, highlighting the necessity for vigilant allergy assessment,” the researchers wrote.
Their paper, titled “A common drug, an uncommon reaction: The combination of amoxicillin-clavulanic acid induced acute allergic reaction with urticaria and angioedema – A case study,” was published in the journal Medical Reports.
In acute allergic angioedema, a form of the rare disease, swelling is triggered by an allergic reaction. Amoxicillin-clavulanic acid is a combination antibiotic that’s commonly used to help manage bacterial infections. This antibiotic is usually well tolerated, but in rare cases, patients can develop an allergic reaction.
That’s what happened here. The case centers on a 38-year-old woman who received an injection of amoxicillin-clavulanic acid during an elective caesarean section. The patient had had three previous uneventful oral exposures to this antibiotic.
Use of antibiotic combo triggered an allergic reaction
The baby was delivered safely, but shortly after receiving the antibiotic injection, the woman started to report sensations of itchiness and prickling across her entire body. She then broke out in hives, with swelling of her face, lips, and tongue.
Immediately after the allergic reaction was recognized, doctors began administering corticosteroids and a vasopressor — a drug used in critical care situations to treat low blood pressure — to counteract the reaction. But despite initial treatment, the woman became unconscious, and monitoring showed she had stopped breathing and her heart had stopped beating. This type of severe, life-threatening allergic reaction is known as anaphylaxis.
Emergency procedures included a shot of pure adrenaline directly into the bloodstream and the administration of cardiopulmonary resuscitation, or CPR. The woman also was placed on a ventilator to help her breathe.
Over the next several hours, doctors administered a variety of medications and provided supportive care, aiming to stabilize the woman’s condition.
Ultimately, the team was successful: The patient regained consciousness and was taken off the ventilator about seven hours later. Her condition stabilized, and after a few days of hospital monitoring, she was discharged.
This case illustrates a rare and severe drug-induced allergic reaction leading to anaphylaxis … The patient recovered with appropriate interventions, emphasizing the importance of early recognition and aggressive management of drug allergies [during surgery].
The woman went back to the hospital a few days later, complaining of breathlessness, and was found to have some minor buildup of fluid around the lungs — an issue that commonly arises in people who have been recently taken off a ventilator. She was given supplemental oxygen and supportive care and recovered a few days later.
She has since had no further issues, the team reported.
The researchers say this case serves as a reminder for clinicians to remain vigilant, even when using the most common medications.
“This case illustrates a rare and severe drug-induced allergic reaction leading to anaphylaxis … The patient recovered with appropriate interventions, emphasizing the importance of early recognition and aggressive management of drug allergies [during surgery],” the team concluded.
