000630 - Severe Drug-Induced Anaphylaxis After Naproxen Sodium Administration: A Case Report

Title

Severe Drug-Induced Anaphylaxis After Naproxen Sodium Administration: A Case Report

Background

Drug-induced anaphylaxis represents a potentially life-threatening condition requiring rapid recognition and management. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequent triggers.

Case Presentation

We report the case of a 58-year-old patient with a medical history of arterial hypertension, previous ischemic stroke, surgically treated pheochromocytoma, and lumbar disc herniation (L4–L5), who presented to the emergency department with generalized urticaria, intense pruritus, dyspnea, facial angioedema, and loss of consciousness. Symptoms developed approximately 30 minutes after oral administration of Naproxen Sodium for elbow pain.

Emergency treatment was initiated by the ambulance team, with near-complete resolution of symptoms upon arrival at the emergency department. On admission, vital signs were stable (SpO₂ 95%, BP 125/80 mmHg, HR 70 bpm). Laboratory investigations revealed leucocytosis with neutrophilia, elevated C-reactive protein, hyperglycaemia, and mildly impaired renal function.

The patient received intravenous fluids, systemic corticosteroids, antihistamines, and proton pump inhibitors, with favorable clinical evolution and no recurrence of symptoms during hospitalization.

Outcome and Follow-up

The patient was discharged with recommendations to avoid NSAIDs, to use selective COX-2 inhibitors if needed, and to carry an epinephrine auto-injector (300 µg) at all times. Further evaluation for Naldorex was recommended after 10–14 days.

Conclusion

This case highlights the importance of early recognition and prompt treatment of drug-induced anaphylaxis. NSAID-related hypersensitivity reactions may occur even in patients without prior known drug allergies, emphasizing the need for careful drug history assessment and appropriate patient education upon discharge.