Death Due to Furosemide Anaphylaxis and The Importance of Serum Tryptase Level in Diagnosing Anaphylaxis: A Case Report

Abstract

Anaphylaxis is a severe systemic hypersensitivity reaction with a sudden onset and may result in death. In this study, we report the case of a 71-year-old female patient who died within seconds after the administration of intravenous furosemide in emergency service; she had high serum tryptase levels at postmortem examination and nonspecific findings at autopsy, and death due to anaphylaxis was reported. With this study, we wanted to point to the rare and potentially fatal drug anaphylaxis, such as furosemide anaphylaxis. Also, our results indicate the importance of serum tryptase levels in the diagnosis of death due to anaphylaxis. Keywords Furosemide, anaphylaxis, postmortem diagnosis, serum tryptase levels. References * 1. Muñoz-Cano R, Picado C, Valero A, Bartra J. Mechanisms of Anaphylaxis Beyond IgE. J InvestigAllergolClinImmunol. 2016;26:73-82. * 2. Simons FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, et al. 2015 update of the evidencebase: World AllergyOrganizationanaphylaxisguidelines. World Allergy Organ J. 2015;8:32. * 3. Hansbrough JR, Wedner HJ, Chaplin DD. Anaphylaxis to intravenousfurosemide. J AllergyClinImmunol. 1987;80:538-41. * 4. Domínguez-Ortega J, Martínez-Alonso JC, Domínguez-Ortega C, Fuentes MJ, Frades A, Fernández-Colino T. Anaphylaxis to oral furosemide. AllergolImmunopathol (Madr). 2003;31:345-7. 5. Machtey I. Sudden death afterintramuscularfrusemide. Lancet. 1968;2:1301. * 6. Osborn, M, Chambers, D, Parcq, J, et al. Guidelines on autopsy practice: Autopsy for suspected acute anaphylaxis (includes anaphylactic shock and anaphylactic asthma). R. Coll. Pathol. 2018;1–12 * 7. Schwartz LB. Diagnostic Value of Tryptase in Anaphylaxis and Mastocytosis. C. 26, Immunology and AllergyClinics of North America. ImmunolAllergyClin North Am; 2006;26:451-63. * 8. Passia E, Jandus P. Using Baseline and Peak Serum Tryptase Levels to DiagnoseAnaphylaxis: a Review. ClinRevAllergyImmunol. 2020;58:366-76. * 9. Valent P, Akin C, Arock M, Brockow K, Butterfield JH, Carter MC, et al. Definitions, criteria and global classification of mastcelldisorders with specialreference to mastcellactivationsyndromes: a consensusproposal. IntArchAllergyImmunol. 2012;157:215-25. * 10. Tse R, Wong CX, Kesha K, Garland J, Tran Y, Anne S, et al. Post-mortem tryptase cut-offlevelforanaphylactic death. Forensic SciInt. 2018;284:5-8. * 11. Turner PJ, Jerschow E, Umasunthar T, Lin R, CampbellDE,Boyle RJ. FatalAnaphylaxis: Mortality Rate and Risk Factors. J AllergyClinImmunolPract. 2017;5:1169-78. * 12. Xiao N, Li DR, Wang Q, Zhang F, Yu YG, Wang HJ. Postmortem Serum Tryptase Levels with Special Regard to AcuteCardiacDeaths. J Forensic Sci. Eylül 2017;62:1336-8. * 13. Kervinen H, Kaartinen M, Mäkynen H, Palosuo T, Mänttäri M, Kovanen PT. Serum tryptase levels in acutecoronarysyndromes. Int J Cardiol. 2005;104:138-43. * 14. Orhan F, Civelek E, Şahiner ÜM, Arga M, Can D, Çalıkaner AZ, et al. Anaphylaxis: TurkishNationalGuideline 2018. AsthmaAllergyImmunol 2018; 16 (Suppl 1):1-62.