Amphotericin B Induced Anaphylactic Reaction and Electrolyte Imbalance: A Case Report

Amphotericin B, a polyene antifungal antibiotic derived from a strain of Streptomyces nodosus. It acts by binding to sterols in the cell membrane of susceptible fungi, with a resultant change in the permeability of the membrane. Amphotericin B can cause allergic reactions, electrolyte imbalance and severe side effects, such as chest discomfort accompanied by dyspnea, flushing, agitation, tachypnea, tachycardia, hypoxemia, hypotension, or hypertension, are likely to develop following the injection of Amphotericin B. Anaphylaxis, cardiac toxicity and respiratory failure have also been associated to different formulations of Amphotericin B as life-threatening acute events. This case report is on a 57-year-old male patient who was admitted with a condition of left diabetic foot with non-healing medial supra heel ulcer and fungal infection on the site of wound. The patient was given Amphotericin B in emulsion form due to the high priority of fungal infection and the need for antifungal medicine, which led to anaphylactic reaction and electrolyte imbalance, which were treated immediately and the same preparation was continued with a low infusion rate. When infusion is discontinued, antihistamines can assist to alleviate the symptoms. In this case, it is recommended that the patient's condition and clinical parameters should be closely followed after the medicine has been administered.

Membranous nephropathy associated with IgG4-related disease successfully treated with obinutuzumab

IgG4-releated disease is typically associated with interstitial nephritis, but rare cases of idiopathic membranous nephropathy as renal manifestation have been described. Obinutuzumab was successfully used in refractory membranous nephropathy, but evidence for the treatment of IgG4-related disease with obinutuzumab is lacking so far. We report one patient's case with membranous nephropathy associated with IgG4-related disease, who was treated with obinutuzumab following anaphylactic reaction to rituximab. Obinutuzumab treatment resulted in a sustained complete remission of membranous nephropathy and decrease of IgG4 to the normal range. This case demonstrates that membranous nephropathy associated with IgG4-related disease can successfully be treated with obinutuzumab.

Case: Unexpected development of severe penicillin allergy and review of literature

A 54-year old male developed unexpectedy a severe penicillin allergy after 5 standard erysipelas treatments by intravenous benzylpenicillin and/or oral phenoxymethylpenicillin without any clinical symptoms of allergy during 16 years. During the 6th erysipelas treatment by intravenous benzylpenicillin, the patient experienced an anaphylactic reaction within 30 minutes.

The role of glucocorticoids in the treatment of acute anaphylactic reaction

Food allergy is a growing health problem, which is particularly common among the youngest children. Anaphylaxis, which is defined as a sudden-onset and potentially fatal response to an allergen, is an indication for urgent treatment. Although intramuscular epinephrine is the treatment of choice, all therapeutic algorithms also recommend glucocorticoids. They play an important role in reducing the risk of late allergic reaction, and, due to their non-genomic effects, are also increasingly often mentioned in the context of early response to shock. This effect is directly proportional to the dose of the drug, and a reduced duration of the symptoms of anaphylactic shock is achieved with the use of high doses of glucocorticoids. The paper presents a case of a 3-month-old girl with an anaphylactic reaction after consuming a modified milk preparation. After systemic administration of glucocorticoids, a satisfactory therapeutic effect was observed in the child.

A case of anaphylactic shock induced by sugammadex in China

Sugammadex, an antagonist of neuromuscular blocking drugs, was used to rapidly reverse rocuronium induced neuromuscular blockade by encapsulating free rocuronium molecules as inclusion complexes. Because it can enhance the rapid recovery after surgery, summadex is gradually used in clinical. There are relatively few reports about anaphylactic reaction to it. We will present a case of severe anaphylactic shock induced by summadex, as the first in China. Author biography: At present, Wei pan is a junior doctor in Shuguang Hospital Affiliated to Shanghai University of traditional Chinese medicine. She graduated from the anesthesia College of Xuzhou Medical University with a master's degree at the age of 27.