S6374 The Pill That Pushed Too Far: A Shocking Reaction

Introduction: Proton pump inhibitors (PPIs) are among the most widely prescribed medications for acid-related gastrointestinal disorders. Although generally well-tolerated, they are increasingly recognized as potential culprits in severe hypersensitivity reactions. This case highlights a rare presentation of pantoprazole-induced anaphylactic shock. Case Description/Methods: An 81-year-old woman presented with intractable nausea and vomiting. Abdominal computed tomography (CT) imaging revealed proximal gastric wall thickening, prompting consideration for esophagogastroduodenoscopy (EGD). She was started on intravenous pantoprazole for symptom management. Within 24 hours, the patient developed a diffuse erythematous skin rash, high-grade fevers, and hypotensive shock requiring vasopressor support despite aggressive fluid resuscitation. Infectious workup, including blood and urine cultures and chest imaging, was unrevealing. With no identifiable infectious source and a temporal relationship to pantoprazole initiation, a diagnosis of drug-induced hypersensitivity reaction was suspected. Pantoprazole was discontinued, resulting in rapid clinical improvement and resolution of hemodynamic instability. The skin rash gradually resolved without further intervention. EGD was later performed and was unremarkable. The patient was discharged in stable condition, and pantoprazole was documented as an allergic medication in her medical record. Discussion: PPI-induced hypersensitivity reactions can present with a spectrum ranging from mild rash to life-threatening anaphylaxis or shock. Diagnosis is often clinical and hinges on the exclusion of other causes, particularly sepsis. Early recognition and withdrawal of the offending agent are critical for rapid recovery and prevention of further complications. Different PPI’s may carry varying risks and severities of adverse effects. Clinicians should be wary of these side effects and avoid prescribing them to patients with a history of hypersensitivity to pantoprazole or related compounds. Further research is needed to understand the short and long-term effects of PPI use.