Taurolidine-induced Severe Anaphylaxis

Abstract

Taurolidine-based catheter lock solutions are widely used for central venous catheters. Although minor infusion-related symptoms and allergic reactions have been documented, no systemic effects or severe cases of anaphylaxis have been observed. Here, we detail a case of taurolidine-induced life-threatening anaphylaxis. We report the case of a 59-year-old man who had a severe anaphylactic reaction to taurolidine following accidental intravenous infusion, which required treatment in the intensive care unit. Anaphylactic shock, which was resistant to conventional treatment with epinephrine, required additional management with norepinephrine and vasopressin. After the resolution of the anaphylactic episode, the patient was discharged from the intensive care unit. An outpatient allergy work-up using a skin prick test was performed, which confirmed a suspected allergy to taurolidine. In conclusion, taurolidine induced a severe, prolonged anaphylactic shock that did not respond to conventional treatment with intravenous and inhaled epinephrine, antihistamines, glucocorticoids, or continuous norepinephrine infusion. New treatment strategies for refractory anaphylactic shock are needed.

Keywords: Allergic reaction; allergy; catheter lock solution; epinephrine; shock.

Figure 1

Blood pressure and heart rate over time. The figure shows the patient’s blood pressure and heart rate over time (green dots denote the heart rate, red lines denote the systolic and diastolic blood pressure and mean arterial pressure). From onset of anaphylaxis and arrival of the medical emergency team up to 55 minutes (time of successful placement of an arterial line), no noninvasive blood pressure could be measured (gray-marked area). During this time period, the patient was blurred but responsive to pain. The placement of an arterial line was delayed because of a difficult vascular anatomy. After placement, continuous norepinephrine was stopped and replaced by epinephrine and vasopressin, which led to intermittent blood pressure overcorrection. Continuous epinephrine and vasopressin could be successfully weaned within the next hours. Arrows (↑) denote a semiquantitative measurement of catecholamine doses. Given the emergency circumstance, the initial catecholamine doses were not accurately documented.