Late‐onset anaphylactic reactions following i.v. cyclophosphamide pulse in a patient with systemic sclerosis and systemic lupus erythematosus overlap syndrome

Abstract

Late-onset anaphylactic reaction is a rare adverse effect of i.v. cyclophosphamide pulse (IVCY), which is caused by cyclophosphamide metabolites. We herein report a case of scleroderma and lupus overlap syndrome who developed anaphylactic reactions 3 h to 4 days after IVCY. Long time lapses between IVCY and appearance of symptoms are compatible with type I hypersensitivity to cyclophosphamide metabolites, appearing as late-onset anaphylactic reaction. Albeit unusual, this is an important anaphylactic reaction to be aware of following IVCY.

Anaphylactic shock with methylprednisolone, Kounis syndrome and hypersensitivity to corticosteroids: a clinical paradox

“…Recent reports have shown that atopic patients suffering from systemic lupus erythematosus have more severe disease at diagnosis and poorer outcomes than SLE patients without atopy [ 10 ]. Furthermore, late-onset anaphylactic reactions following intravenous cyclophosphamide pulse in a patient with systemic sclerosis and systemic lupus erythematosus overlap syndrome have been also encountered [ 11 ]. Therefore, atopy seems to constitute a disease-substrate that predispose to allergic and anaphylactic reactions.…”