Anaphylaxis following a pleural puncture bringing back a rock water-like liquid

Abstract

Introduction : Anaphylaxis is a life-threatening medical emergency. Its occurrence in the hospital environment should lead to the first evocation
of a drug allergy or a latex allergy. However, many other etiologies need to be investigated early.
We publish this case report to highlight a rare differential diagnosis of drug allergy, namely hypersensitivity caused by Ecchinoccocus granulosis.
Clinical case :An 18-year-old female patient with no previous pathological history, from a rural environment, consulted for a 4-month history
of right basi-thoracic pain without any other associated clinical sign. Her physical examination revealed a right pleuritic syndrome. Chest
radiograph showed a right pleural opacity. The patient had a pleural puncture bringing back a rocky water-like fluid. Five minutes later, the
patient had an injection of paracetamol to relieve the pain. Thirty minutes later, plaques of urticaria on the extremities and trunk and arterial
hypotension occurred. The diagnosis of grade III anaphylaxis was retained. Following vascular filling and administration of antihistamines, the
evolution was rapidly favorable. The thoraco-abdominal ultrasound showing the presence of a ruptured liver hydatid cyst in the pleura. A surgical
treatment was thus proposed. Despite contact with latex gloves and the administration of paracetamol after surgery, the patient did not present
any allergic reaction. Thus the retained cause of the anaphylaxis was ecchinoccocus granulosis.
Conclusion: Anaphylaxis following a pleural puncture bringing back a rock water-like liquid must suggest the diagnosis of complicated hydatic cyst