Unveiling the Uncommon: A Case Report of Anaphylaxis with Rare Presentation

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction. Anaphylactic reactions commonly present with hypotension. However, the incidence of hypertensive anaphylaxis is relatively uncommon. Only a few literary works are available on hypertensive anaphylaxis. A 68-year-old woman arrived to the emergency room with complaints of hoarseness of voice and breathing difficulty after being stung by a wasp an hour back. On arrival in the emergency room, she was tachypnoeic, with a saturation of 89% in room air, blood pressure (BP) of 180/110mmHg, and heart rate (HR) of 110 bpm. There was hoarseness of voice, swollen tongue, and bilateral rhonchi on chest auscultation. A diagnosis of anaphylaxis was made and managed with intramuscular adrenaline, intravenous (IV) hydrocortisone, IV pheniramine, and IV adrenaline. Her BP remained persistently high till the anaphylaxis started to resolve. Once the patient started showing improvement in her symptoms, her blood pressure came down to 160/80mmHg, and her blood pressure on discharge was 130/70mmHg. It's unusual for anaphylaxis to present with hypertension. Anaphylaxis can present with hypertension also as compared to the usual hypotension. Adrenaline remains the first line in anaphylaxis. In a scenario with high BP with anaphylaxis, adrenaline can be given under strict haemodynamic monitoring. Do not hesitate to administer adrenaline in anaphylaxis, and always keep in mind the possibility of hypertensive anaphylaxis.