Obstet Gynecol Sci.  2018 Sep;61(5):636-640. 10.5468/ogs.2018.61.5.636.

Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

Affiliations
  • 1Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea. sarahmd@ewha.ac.kr

Abstract

Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.

Keyword

Anaphylaxis; Shock; Hysteroscopy; Misoprostol

MeSH Terms

Anaphylaxis*
Cervical Ripening
Dilatation and Curettage
Female
Fever
Humans
Hypotension
Hysteroscopy
Labor Stage, First
Middle Aged
Misoprostol*
Mortality
Pregnancy
Pregnant Women
Shock
Misoprostol

Figure

  • Fig. 1 Clinical features of generalized edema caused by anaphylactic shock to intravaginal misoprostol. (A) Facial and neck edema. (B) Hand edema at 20 hours after the onset of anaphylactic shock.

  • Fig. 2 Chest X-ray and chest computed tomography findings. (A) Chest X-ray showing interstitial pulmonary edema without cardiomegaly or pleural effusion. (B) An axial, contrast-enhanced computed tomography scan showing alveolar and interstitial pulmonary edema without evidence of pulmonary embolism.


Reference

1. Hofmeyr GJ, Gülmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2003; CD000941.
Article
2. Selk A, Kroft J. Misoprostol in operative hysteroscopy: a systematic review and meta-analysis. Obstet Gynecol. 2011; 118:941–949.
3. Polyzos NP, Zavos A, Valachis A, Dragamestianos C, Blockeel C, Stoop D, et al. Misoprostol prior to hysteroscopy in premenopausal and post-menopausal women. A systematic review and meta-analysis. Hum Reprod Update. 2012; 18:393–404.
Article
4. Berek JS, Novak E. Berek & Novak's gynecology. 15th ed. Philadelphia (PA): Lippincott Williams & Wilkins;2012.
5. Casadei L, Piccolo E, Manicuti C, Cardinale S, Collamarini M, Piccione E. Role of vaginal estradiol pretreatment combined with vaginal misoprostol for cervical ripening before operative hysteroscopy in postmenopausal women. Obstet Gynecol Sci. 2016; 59:220–226.
Article
6. Schoen C, Campbell S, Maratas A, Kim C. Anaphylaxis to buccal misoprostol for labor induction. Obstet Gynecol. 2014; 124:466–468.
Article
7. Béné J, Alarcon P, Faucon M, Auffret M, Delfosse F, Becker T, et al. Anaphylactic shock after misoprostol in voluntary termination of pregnancy—a case report. Eur J Obstet Gynecol Reprod Biol. 2014; 182:260–261.
8. Schellenberg RR, Isserow SH. Anaphylactoid reaction to a cyclooxygenase-2 inhibitor in a patient who had a reaction to a cyclooxygenase-1 inhibitor. N Engl J Med. 2001; 345:1856.
Article
9. Soter NA, Austen KF. Urticaria/angioedema. The mast cell, its diverse mediators, and its role in cutaneous inflammation. In : Safai B, Good RA, editors. Immunodermatology. Comprehensive immunology, volume 7. New York (NY): Springer;1981. p. 273–292.
10. Perskvist N, Edston E. Differential accumulation of pulmonary and cardiac mast cell-subsets and eosinophils between fatal anaphylaxis and asthma death: a postmortem comparative study. Forensic Sci Int. 2007; 169:43–49.
11. Babakhin AA, Nolte H, DuBuske LM. Effect of misoprostol on the secretion of histamine from basophils of whole blood. Ann Allergy Asthma Immunol. 2000; 84:361–365.
Article
12. Madaan M, Puri M, Sharma R, Trivedi SS. Hypersensitivity reaction to misoprostol—a case report. Int J Clin Med. 2012; 3:223–224.
Article
13. Meuleman C, Jourdain P, Bellorini M, Guillard N, Loiret J, Thebault B, et al. Anaphylactic shock and myocytic necrosis after treatment with Artotec. Arch Mal Coeur Vaiss. 2002; 95:1230–1233.
14. Tang AW. A practical guide to anaphylaxis. Am Fam Physician. 2003; 68:1325–1332.
15. Chiam E, Weinberg L, Bellomo R. Paracetamol: a review with specific focus on the haemodynamic effects of intravenous administration. Heart Lung Vessel. 2015; 7:121–132.
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