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


Soumaya Ben Saad
Amani Ben Mansour
Azza Slim
Henda Neji
Mahdi Abdenadher
Hafaoua Daghfous
Fatma Tritar


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


Anaphylaxis, allergy, hydatic cyst, ecchinoccocus granulosis, pleural punction



  1. S Fernandez, P Pralong, JF Nicolas. Œdème de Quincke et anaphylaxie. Rev Prat 2012;62:829-35.
  2. Zendah I, Ben Saad S, Daghfous H, Ayadi A, Toujani S, Merai A et al. Kyste hydatique de la paroi thoracique mimant une métastase de cancer colique. Rev Pneum Clin. 2009,65:357-60.
  3. Mirijello A, Pepe G, Zampiello P, Criconi GM, Mendola 3, Antonio Manfrini A. A Male Patient with Syncope, Anaphylaxis, and ST-Elevation: Hepatic and Cardiac Echinococcosis Presenting with Kounis Syndrome. J Emerg Med 2016 Oct;51(4):e73-7.
  4. Marashi S; Hosseini V; Saliminia A; Yaghooti A. Anaphylactic Shock During Pulmonary Hydatid Cyst Surgery. Anesth Pain Med. 2014;4(3): e16725.
  5. Ghazali H, Gammoudi M, Yahmadi A, Chaaebeni G, Souyah a, Souissi S. Anaphylaxie aux urgences : Étude des caractéristiques épidémio-cliniques et thérapeutiques. Tun Med. 2017;95:45-52