Severe Anaphylaxis Following Intradermal Test Dose of Ceftriaxone

Abstract Ceftriaxone is a third-generation cephalosporin antibiotic used commonly for treating infections; however, hypersensitivity reactions, including anaphylaxis, occur in approximately 1%–3% of patients. Anaphylaxis can vary from minor skin rashes to life-threatening events affecting multiple organ systems, making it challenging for anesthesiologists. We present a case of severe anaphylaxis resulting in anaphylactic shock after an intradermal test dose of ceftriaxone in a 55-year-old female undergoing umbilical hernia mesh repair. The patient was a well-controlled hypertensive who came with stable vital signs before surgery. However, soon after administering the test dose, she began to exhibit asystole and unresponsiveness; hence, cardiopulmonary resuscitation immediately commenced, along with intravenous administration of adrenaline. Although consciousness returned, she failed to show palpable pulses while maintaining adequate respiratory effort. She was put on 100% oxygen with noninvasive ventilation and managed on noradrenaline and adrenaline infusions due to significant hypotension. After 6 days in critical care, the patient’s condition improved, allowing for weaning from the ventilator and eventual discharge. This incident, despite a negative history of allergy testing, points to the unpredictable nature of drug hypersensitivity and the importance for anesthesiologists and surgical teams to be keen on monitoring patients. As there was normal recovery with adequate left ventricular function, we did not think in terms of any other cause. Clear documentation of such reactions is essential for future medical care, underlining the importance of complete allergy reviews to avoid similar life-threatening events. This case is also an important reminder about the vigilance that should be maintained during the perioperative period.