QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liu, P.-Y. Articles by Chen, J.-H. Search for Related Content PubMed PubMed Citation Articles by Liu, P.-Y. Articles by Chen, J.-H.

Refractory Anaphylactic Shock Associated with Ketoconazole Treatment

Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center; Institute of Clinical Medicine, National Cheng-Kung University, Tainan, Taiwan

Cheng-Han Lee, MD

Senior Fellow of Cardiovascular Medicine, Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center

Li-Jen Lin, MD

Chief of Cardiovascular Medicine, Associate Professor of Medicine, Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center

Jyh-Hong Chen, MD PhD FACC

Dean of National Cheng-Kung University Hospital; Professor of Medicine, Division of Cardiology, Department of Internal Medicine, National Cheng-Kung University Medical Center

Reprints: Dr. Liu, National Cheng-Kung University Medical Center and Institute of Clinical Medicine, National Cheng-Kung University, No.138 Sheng-Li Rd., Tainan 704, Taiwan, fax 886-6-2753834, larry{at}mail.ncku.edu.tw

OBJECTIVE: To report a rare but severe reaction of refractory anaphylactic shock with ketoconazole treatment–associated hypotensive episodes in an elderly patient.

CASE SUMMARY: A 72-year-old woman received antifungal therapy for her almost completely occluded cornea infected with Candida albicans. She was initially prescribed oral ketoconazole 200 mg twice daily. She developed hypotension over the first 2 days of therapy (BP 136/82 mm Hg at baseline; 90/50 mm Hg on day 2). Severe hypotension (BP 90/49 mm Hg) unresponsive to fluid therapy or high-dose dopamine developed on day 4 of therapy. An invasive Swan–Ganz catheterization study showed a very low level of peripheral vascular resistance with high cardiac output index without clinical signs of infection. When laboratory tests showed a high level of plasma tryptase, anaphylactic redistribution shock was diagnosed. Her vital signs became more stable after treatment with hydrocortisone and epinephrine infusion. She was discharged in good condition after 24 hours of observation.

DISCUSSION: As of December 2004, refractory anaphylactic shock resulting from ketoconazole use had not been reported. The events of hypotension were strongly associated with the intake of ketoconazole. The hemodynamic results obtained with Swan–Ganz catheterization were compatible with anaphylactic shock. The Naranjo probability scale showed a probable association of the adverse event with ketoconazole.

CONCLUSIONS: Ketoconazole may cause severe anaphylactic shock even when taken orally. Invasive catheterization and elevated tryptase levels can provide important information in the management of anaphylactic shock.

Key Words: anaphylactic shock, ketoconazole, tryptase

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E465

This article has been cited by other articles:

				J. Chen, X. Song, P. Yang, and J. Wang Appearance of Anaphylactic Shock after Long-Term Intravenous Itraconazole Treatment Ann. Pharmacother., March 1, 2009; 43(3): 537 - 541. [Abstract] [Full Text] [PDF]