Case presentation: This report regards a 60-year-old man affected by heterozygous familial hypercholesterolemia associated with high levels of lipoprotein (a), coronary and polidistrectual atherosclerotic disease. Patient has been treated with Atorvastatin 20 mg OD and LDL-apheresis (Heparin mediated LDL precipitation system every 2 weeks treating 4000 ml of plasma for session) for eight years. Patient was regularly treated without any relevant problem, but unexpectedly, he presented two consecutive episodes of systemic malaise characterized by sweating, paresthesias of the lips and flush. In the second episode, these symptoms were followed by bradycardia and presyncopal episode. Both events occurred after more than 2 hours treatment, and were cured with fluid administration and bolus of 500 mg methylprednisolone i.v. Blood pressure, normal before the LDL apheresis start of, was low but responsive to administration of fluids. The symptoms, however, were so grave to require the discontinuation of LDL apheresis procedures. At the revaluation of the possible causes of these unexpected episodes, occurred in absence of technical problems and without drug therapy modifications (aspirin 100 mg OD, atenolol 50 mg OD and ramipril 5 mg OD), we observed changes in the lifestyle: at dinner, the patient drank 2 or 3 glasses of white wine craft produced. The following apheresis was performed without drinking wine and we did not report any inconvenient. Furthermore, no problems occurred in the subsequent 9 apheresis performed so far with this setting.
A case of ‘anaphylactic-like’ reaction during LDL apheresis: a pathophysiological hypothesis on white wine containing metabisulphite
CARDINALI, Gianluigi;
2016
Abstract
Case presentation: This report regards a 60-year-old man affected by heterozygous familial hypercholesterolemia associated with high levels of lipoprotein (a), coronary and polidistrectual atherosclerotic disease. Patient has been treated with Atorvastatin 20 mg OD and LDL-apheresis (Heparin mediated LDL precipitation system every 2 weeks treating 4000 ml of plasma for session) for eight years. Patient was regularly treated without any relevant problem, but unexpectedly, he presented two consecutive episodes of systemic malaise characterized by sweating, paresthesias of the lips and flush. In the second episode, these symptoms were followed by bradycardia and presyncopal episode. Both events occurred after more than 2 hours treatment, and were cured with fluid administration and bolus of 500 mg methylprednisolone i.v. Blood pressure, normal before the LDL apheresis start of, was low but responsive to administration of fluids. The symptoms, however, were so grave to require the discontinuation of LDL apheresis procedures. At the revaluation of the possible causes of these unexpected episodes, occurred in absence of technical problems and without drug therapy modifications (aspirin 100 mg OD, atenolol 50 mg OD and ramipril 5 mg OD), we observed changes in the lifestyle: at dinner, the patient drank 2 or 3 glasses of white wine craft produced. The following apheresis was performed without drinking wine and we did not report any inconvenient. Furthermore, no problems occurred in the subsequent 9 apheresis performed so far with this setting.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
