D3.60 - Allergic reaction in bisoprolol overdose

Bisoprolol is a beta-1 selective beta-blocker used to treat hypertension, heart failure, chronic stable angina, and arrhythmias.  It is generally well-tolerated, though it can cause bradycardia, fatigue, or hypotension in some patients.

• Patient M.J 71 years old, female
• Medical history: Diagnosed with Multiple Myeloma 2 years ago, Hypertension 15 years
• Chemotherapy : Recently started lenalidomide for multiple Myeloma
• Current medications: Bisoprolol 5 mg, Losartan, Amlodipine and paracetamol 500 mg taken 3 days ago
• Clinical Findings on Admission:
• Vital signs:• Cardiac frequency: 68 bpm
• • Oxygen saturation: 97%• Blood pressure: 140/80 mmHg
• Skin Lesions:
• • Erythema on the face and abdomen, with new lesions appearing on the axillae and upper and lower extremities. 
• • Desquamation has started on the face since hospitalization.
• • The patient had erythema that began 2 weeks ago with the initiation of chemotherapy (lenalidomide), which improved over time, but worsened after the bisoprolol overdose.
• Laboratory Findings:
• • Eosinophils: Elevated at 1.0 k/µL, suggesting a possible eosinophilic reaction• Neutrophils: Elevated at 72.6%  indicating infection.
• • Lymphocytes: Decreased at 13.5% a response to acute stress, infection.• Red Blood Cells: 2.2 million/µL  indicating anemia.
• • Hemoglobin: 7 g/dL  confirming severe anemia.• Transaminases: Normal, indicating no liver damage at the time of admission.
• Diagnosis :Bisoprolol overdose. Drug-induced skin reaction, possibly by chemotherapy (lenalidomide) and exacerbated by bisoprolol overdose. Treatment:Gastric lavage with saline was performed immediately upon admission to treat the bisoprolol overdose.Skin drug reaction was treated with corticosteroids and antihistamine.The patient was monitored for potential cardiac effects , infection and skin reactions.
• Conclusions:This case highlights the potential complications of bisoprolol overdose in patients undergoing chemotherapy and with comorbid conditions like hypertension and multiple myeloma. The presence of eosinophilia, neutrophilia, lymphocytopenia, and severe anemia suggests a complex interaction of drug-induced hypersensitivity, chemotherapy-related effects, and overdose-related complications. Monitoring for cardiovascular, cutaneous, hematological, and infectious reactions is essential, especially when polypharmacy is involved.