Case details
An 18-year-old man diagnosed with Hodgkin’s lymphoma was admitted to the Specialized Center for Bone Marrow Transplantation for autologous stem cell transplantation.
The LEAM (Lomustine, Cytarabine, Etoposide, and Melphalan) therapeutic protocol was used as a conditioning regimen before stem cell transplantation according to the National Health Service (NHS) protocol[15].
Three days after stem cell transplantation (day +4), the patient entered a state of low neutrophil count, which was equal to (35) μl. On the next day (day +3), the patient’s temperature elevated to 38°C, which was considered as neutropenic fever. The doctor began dispensing antibiotics to the patient, such as Piperacillin+Tazobactam, and then Meropenem, but the temperature did not decrease. The doctor added Vancomycin treatment in order to cover the gram-positive bacteria, then he added Amikacin, but to no benefit. On the eighth day after the cell transplantation (day +9), the doctor added the liposomal Amphotericin (Ambisome) therapy in order to control the neutropenic fever. The dose of Ambisome) was calculated on the basis of the patient’s weight[11], which was compromising 70 kg, 210 mg of Ambisome in 500 ml of glucose-water 5% (D5W) infused over two hours. As a liposomal amphotericin is safer than conventional amphotericin, The treatment of Ambisome was given without sensitivity test or the addition of hydrocortisone and Chlorpheneramine before it[16].
After completing the infusion of the Ambisome, the patient suffering from skin rash, redness and chills accompanied by elevation in body temperature, increase pulse rate, a drop in blood pressure, and a decrease in the percentage of blood saturation with oxygen, as shown in the table 1 . In order to ascertain the possibility that the drug is the cause of hypersensitivity, the Naranjo score was calculated and it was equal to (5). This indicates that the drug caused the hypersensitivity reaction[17].
The physicians prescribe hydrocortisone vial 100 mg plus chlorpheneramine ampoule, Normal saline 0.9% and Oxygen therapy to manage patient sever allergy. After the rapid intervention, the patient’s condition was clinically stable.