Anaphylaxis following the third dose of Meropenem leading to acute respiratory distress syndrome and multi-organ failure: A case report

Abstract

Background: Diabetic ketoacidosis (DKA) with acute cholecystitis can present complex management challenges. Anaphylaxis to antibiotics can further complicate recovery, potentially leading to severe sequelae such as acute respiratory distress syndrome (ARDS). Case Presentation: A 47-year-old Asian female with a history of diabetes and hypertension presented with abdominal pain, vomiting, and diarrhea. She was diagnosed with DKA and received resuscitation including intravenous fluids, anti-emetics, and insulin infusion. Initial treatment improved her hemodynamics, but laboratory tests revealed elevated random blood sugar and leukocytosis. Diagnostic imaging confirmed acute calculous cholecystitis. Treatment with meropenem was initiated after a skin sensitivity test. Adverse Reaction: After the third dose of meropenem, the patient developed signs of anaphylaxis, including chest tightness, hypotension, mild hypoxia, tachypnea, and tachycardia. Immediate management included high-flow oxygen, intravenous saline boluses, intramuscular adrenaline, and hydrocortisone. The patient stabilized temporarily but exhibited persistent tachypnea, tachycardia, oliguria, and bilateral inspiratory crepitations on subsequent evaluation. Chest X-ray and echocardiography indicated bilateral white patches and mild generalized hypokinesia, respectively. Complications and Management: The patient’s condition deteriorated into ARDS, requiring intubation, sedation, paralysis, and mechanical ventilation. ARDS protocol treatment, including intravenous methylprednisolone, was administered. Subsequent investigations revealed coagulopathy, acute liver impairment, acute kidney injury, and rhabdomyolysis. All cultures were negative, and conservative management was applied. Outcome: Over several days, the patient’s condition improved with gradual normalization of oxygenation, urine output, and chest X-ray findings. Sedation and paralysis were tapered, and the patient was extubated after 6 days. Follow-up showed significant recovery, and the patient was discharged with education on anaphylaxis. Conclusion: This case highlights the potential for anaphylaxis to precipitate severe complications such as ARDS in patients receiving antibiotics. Prompt recognition and management of anaphylaxis, along with supportive care and ARDS management, are crucial for recovery.