Successful Resuscitation of Anaphylactic Shock With Central Nervous System Dysfunction in a Patient on Multiple Antihypertensive Therapies: A Case Report and Literature Review

Anaphylaxis in patients taking antihypertensive medications is a life-threatening condition. Early recognition and intervention are crucial to reducing mortality, especially when severe organ dysfunction, such as a central nervous system (CNS) disorder, is present. A 69-year-old male patient with hypertension, who was being treated with amlodipine and carvedilol, was admitted following anaphylactic shock. During contrast-enhanced computed tomography for abdominal pain, he developed sudden hypotension, coma, and a generalized rash. Despite intubation and administration of epinephrine and intravenous glucagon, his hypotension persisted, even after initiating continuous noradrenaline infusion. Following repeated bolus infusions of glucagon, his hemodynamics and consciousness improved. He was extubated after 48 hours and discharged on the fifth day. This case highlights clinical challenges in managing anaphylactic shock in patients using antihypertensive drugs, particularly when presenting with life-threatening CNS precursors. Theoretically, epinephrine increases blood pressure via α1- and β1-receptor stimulation; however, concurrent use of β-blockers can impair these responses. In this patient's etiology, glucagon was essential to bypass the β-adrenergic receptors. For patients on α-blockers, vasopressin may serve as a second-line treatment for noradrenaline-resistant shock by acting on vasopressin receptors. Extracorporeal membrane oxygenation should be considered if pharmacological management fails. Furthermore, although this patient was resuscitated with the current protocol, literature suggests that intravenous epinephrine may be necessary if intramuscular administration is ineffective in severe cases. In conclusion, we successfully managed a complex case of anaphylactic shock with CNS dysfunction. Given the lack of robust evidence for managing such refractory cases, further accumulation of case reports or observational studies is warranted.