Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Apr 1;25(2):152-155.
doi: 10.4103/tjem.tjem_180_24. eCollection 2025 Apr-Jun.

A rare case report of catecholamine-induced takotsubo in a patient with anaphylaxis shock due to amoxicillin-clavulanate

Thang Quoc Le  1 , Thanh Huu Nguyen  1 , Anh Duc Vu  2 , Hai Dang Pham  2
Affiliations
Case Reports

A rare case report of catecholamine-induced takotsubo in a patient with anaphylaxis shock due to amoxicillin-clavulanate

Thang Quoc Le et al. Turk J Emerg Med. .

Abstract

Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a life-threatening condition characterized by transient left ventricular dysfunction with nonischemic abnormalities. This syndrome in scenarios of anaphylactic shock is quite rare, with only a few cases reported. Early diagnosis and treatment are crucial. We presented a rare case of 58-year-old woman presented to our hospital due to an anaphylactic shock. The patient was stable and in the de-escalation dose of adrenaline (0.05 µg/kg/h). Twenty-two hours from exposure, the patient experienced pulmonary edema that required intubation, both adrenaline and dobutamine to maintain blood pressure. Echocardiography revealed a reduced ejection fraction of 35%. Subsequent coronary angiography showed no signs of coronary obstruction and left ventriculography provided typical apical ballooning and hyperkinesia in the basal region, highly suggesting TTS. The patient was successfully treated with inotrope and vasopressor and was discharged in stable condition after 7 days and improved normal heart function after 4 weeks. This case demonstrates the delayed onset of adrenaline-induced takotsubo complicated with pulmonary edema in a patient with anaphylactic shock due to antibiotics despite a de-escalation dose of adrenaline. Regardless of the duration of the event or the optimal epinephrine dosage in patients with anaphylactic shock, physicians should be aware of the risk of TTS.

Keywords: Anaphylaxis; antibiotics; catecholamine; takotsubo.

PubMed Disclaimer

Conflict of interest statement

None Declared.

Figures

Figure 1
Figure 1
Echocardiogram (ECG) after 22 h from onset. The ECG showed a reduced ejection fraction of 35%, hyperkinesia in the basal, and hypokinesia at the apical regions. (a) Apical 4-chamber view, (b) Apical 2-chamber view
Figure 2
Figure 2
Echocardiogram (ECG) after 22 h from onset. The ECG showed ST elevation in V4 and V5
Figure 3
Figure 3
The left ventriculography. It showed the typical apical ballooning
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, et al. International expert consensus document on takotsubo syndrome (Part II): Diagnostic workup, outcome, and management. Eur Heart J. 2018;39:2047–62. - PMC - PubMed
    1. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of takotsubo syndrome. Circulation. 2017;135:2426–41. - PubMed
    1. Surineni K, Afzal MR, Barua R, Parashara D. Epinephrine-induced takotsubo cardiomyopathy. Fed Pract. 2016;33:28–30. - PMC - PubMed
    1. Hassan SY. Clinical features and outcome of epinephrine-induced takotsubo syndrome: Analysis of 33 published cases. Cardiovasc Revasc Med. 2016;17:450–5. - PubMed
    1. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical features and outcomes of takotsubo (Stress) cardiomyopathy. N Engl J Med. 2015;373:929–38. - PubMed

Publication types

LinkOut - more resources