In this article, we present a case of development of anaphylaxis during biopsy of cardiac, hepatic, and subcutaneous hydatid cysts.
Table 1. Preoperative laboratory findings of the case
The patient underwent biopsy of the lesion in the dorsal region under sedoanalgesia and local anesthesia. However, during the biopsy, the patient developed an anaphylactic reaction, followed by cardiopulmonary arrest. The patient was given 80 mg of methylprednisolone and 0.3 mg of epinephrine hydrochloride every 15 min. In addition, the patient underwent orotracheal intubation and cardiac massage was performed. Thankfully, the Emergency Team was able to successfully stabilize the patient, and subsequent echocardiography revealed a large hydatid cyst. On echocardiography, the patient's systolic functions were found to be normal. Hydatid cyst lesions were detected in the interventricular septum and left liver lobe on MRI and computed tomography (CT) images (Figure 2). In addition, fluid taken from the scapular region was sent for cytological and pathological examination. Indirect hemagglutination test for hydatid cysts (Echinococcus antibody) resulted in 1/640 positive. Hydatid serology was positive and enzyme-linked immunosorbent assay (ELISA)-based qualitative assessment of E. granulosus immunoglobulin (IgG) antibodies confirmed the diagnosis of echinococcosis. Antiprotozoal drug therapy was initiated. After the patient was stabilized, she was referred to a tertiary cardiac center for the placement of cardiac pacemaker for complete atrioventricular block. A written informed consent was obtained from the parents and/or legal guardians of the patient.
Orthopedic tumors are included in rare disease groups and gaining experience in this regard may take a long time. Many patients are admitted to orthopedic clinics with complaints of masses. If musculoskeletal tumors are suspected, a biopsy is planned. When possible, biopsies are performed in the outpatient setting, thereby reducing both costs and providing more rapid results.
This case demonstrates that potential complications should always be considered during surgical and invasive procedures. All surgical interventions should be performed cautiously, and necessary conditions for anesthesia and intubation should be meticulously provided during all types of procedures, such as biopsy. In addition, in patients with musculoskeletal masses, a whole-body MRI scan may be recommended to identify rare cases. Thus, potential complications can be prevented at an early stage.
As subcutaneous hydatid cysts may occur as a result of the spillage of cyst content into the incision area during visceral hydatid cyst surgeries, the risk of anaphylactic shock is high during the spreading or spillage of cyst content.[7]
In conclusion, fatal complications such as anaphylactic shock should be considered and necessary precautions should be taken during all invasive procedures, such as biopsy. Rare cases provide important contributions to clinical practice and literature.
Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Author Contributions: Idea/concept, design: M.Y.; Control/ supervision: D.A.; Data collection and/or processing: R.B.P.; Analysis and/or interpretation: M.Y., I.G.; Literature review, references and funding: H.U.; Writing the article: M.Y., R.B.P.; Critical review: I.G.; Materials: D.A.
Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Funding: The authors received no financial support for the research and/or authorship of this article.
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