S4087 Cidex Hypersensitivity Following Colonoscopy: Managing Such Reaction in a Limited Resource Setting in a Patient Requiring Frequent Screening Colonoscopies

Introduction: The clinical significance of colonoscopy lies not only in its screening and diagnostic modalities but also in its therapeutic implications. However, sterilization techniques of the colonoscopy equipment through the utilization of different liquid chemical germicide agents such as glutaraldehyde (Cidex) are mandatory to substantially minimize the risk of infection. Hypersensitivity reactions towards the disinfecting agents, such as Cidex, although exceedingly rare and virtually not reported in colonoscopy procedures, should prompt vigilance. Case Description/Methods: A 38-year-old woman with a family history of familial adenomatous polyposis (FAP) presented to our gastrointestinal services with a history of screening esophagogastroduodenoscopy and colonoscopy done at the age of 32 years. She reported that one hour after the colonoscopy procedure, the patient started to complain of diffuse flushing that was accompanied by progressive bloating. Moreover, the patient reported an urticarial skin rash. She was found to be pyrexial and thus clinical picture was suspicious of an allergic reaction. Therefore, she was started on intramuscular epinephrine, intravenous (IV) steroids, and IV antihistamine. Symptoms gradually improved and the patient was discharged home. Due to the finding of multiple colonic polyps on the screening colonoscopy and the family history of FAP, she underwent a second screening colonoscopy 2 years later. Similarly, symptoms of allergic reaction occurred during the second colonoscopy. Following evaluation, it was determined that she has a hypersensitivity reaction to Cidex. In view of her need of frequent colonoscopies and to avoid another allergic reaction, 10 mg of Cetirizine was given the day before the subsequent colonoscopy in addition to 100 mg IV of Hydrocortisone just before the procedure. The patient did not exhibit any symptoms of an allergic reaction following the procedure and was safely discharged home. Discussion: We present one of very few reported cases of Cidex hypersensitivity following colonoscopy. While other disinfecting agents can be utilised in such instances to avoid such allergic reaction, our case is unique in that it is in a limited resource setting where other disinfecting agents are not as commonly available. Additionally, the scopes utilised are not as compatible with other disinfecting agents, thus making Cidex use a necessity. Therefore, by carefully planning for the procedure with antihistamine and steroids, such hypersensitivity reactions can be avoided.