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**Case Report: Intravenous Ribavirin-Induced Anaphylactic Shock**
On admission examination: body temperature 37°C, pulse 90 beats/min, respiratory rate 20 breaths/min, blood pressure 15/10 kPa. No history of drug allergy. The doctor prescribed a compound sodium chloride solution (250 ml) plus cephalexin and cefotaxime sodium (3.0 g daily) for intravenous infusion, along with dexamethasone tapering over 7 days. Fluid input lasted for 20 days. The patient's condition improved, and medication was stopped after 3 days. However, the patient later developed cold symptoms, fever (up to 38°C), chills, chest tightness, shortness of breath, limb weakness, and fatigue.
The doctor then prescribed a compound sodium chloride solution (250 ml) plus cephalexin thiophene oxime sodium (3.0 g) and ribavirin (500 mg) for intravenous infusion. About three minutes into the infusion, the patient developed chest tightness, pallor, cyanosis of the lips and nail beds, dizziness, numbness in the limbs, and cold extremities. The patient became unconscious, with unmeasurable blood pressure and an unclear pulse. A physical examination revealed bilateral pupils that were equal and round. Immediate measures included stopping the intravenous infusion, oxygen inhalation, subcutaneous injection of 1 mg of adrenaline, intravenous injection of 20 ml of 25% glucose plus 10 mg of dexamethasone, and intravenous infusion of dopamine (60 mg) mixed with 250 ml of compound sodium chloride solution. After 30 minutes of emergency treatment, the patient's blood pressure rebounded to 12/8 kPa, pulse rate stabilized at 82 beats/min, and the cyanosis of the lips and nail beds resolved. Consciousness returned, and the patient received symptomatic and supportive therapy for five days before being discharged.
**Discussion:**
Anaphylactic shock is a type I hypersensitivity reaction that occurs rapidly, often caused by drugs. It is more commonly associated with intravenous, intramuscular, or subcutaneous injections but can rarely occur due to other causes. Anaphylactic shock induced by medications typically manifests within about three minutes to 30 minutes after administration. This case involved a patient with no prior history of drug allergies or family history of allergies. Ribavirin (a triazole nucleoside) has shown good efficacy but can also cause adverse reactions.
In another case involving lidocaine administration during surgery, the patient complained of chest tightness and difficulty breathing seven minutes after induction. Blood pressure dropped to 12/8 kPa, and despite interventions such as oxygen administration and ephedrine injections, the patient's symptoms did not fully resolve. The operation proceeded under close monitoring, and post-surgery, the patient experienced prolonged hypotension and difficulty breathing. After fetal delivery, symptoms gradually improved, and the patient's blood pressure returned to normal. No adverse reactions or complications from anesthesia were observed during a 24-hour follow-up.
**Discussion on Cesarean Section Hypotension Syndrome:**
There have been numerous reports of supine hypotension syndrome in pregnant women undergoing cesarean sections, affecting approximately 10–15% of cases. Spinal anesthesia is particularly common in this context. Due to limited clinical experience, the initial diagnosis was mistaken for a general response to anesthesia, leading to inadequate management. Pain increased for the patient, complicating surgical procedures.
In a related case, a 25-year-old married woman with four pregnancies experienced spontaneous abortion at 12 weeks of gestation. Both she and her 26-year-old husband had normal health and semen analysis. They were not consanguineously married. Cytogenetic analysis of peripheral blood lymphocytes revealed that the patient carried a balanced translocation of chromosomes (46, XX). According to genetic principles, when one partner carries a balanced chromosomal translocation, it increases the risk of miscarriage or abnormal offspring.
Further exclusion of related yeast infections and other conditions confirmed the diagnosis. Financial considerations and the couple’s decision to marry were discussed, emphasizing the importance of genetic counseling and informed consent.
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