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

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.