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.