Antithymocyte globulin
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Noncardiogenic pulmonary oedema: case report A 28-year-old man developed noncardiogenic pulmonary oedema after receiving antithymocyte globulin. The man, who had a history of chronic interstitial nephritis leading to chronic renal failure, was scheduled to undergo a laparoscopic renal transplant. Half an hour prior to induction of anaesthesia, he received a test dose injection of antithymocyte globulin [dose not stated], to which he had no reaction. During surgery, he received prophylactic hydrocortisone and chlorphenamine, followed by an infusion of antithymocyte 75mg diluted in 100mL sodium chloride administered over 4 hours through the central line. He also received methylprednisolone as prophylaxis against rejection. After completion of the antithymocyte globulin infusion, during port closure at the end of the 4.5-hour surgery, his airway pressures suddenly increased and resistance was felt on manual ventilation. His oxygen saturation gradually decreased below 90%, despite oxygen supplementation, and bilateral crepitations were detected on auscultation. He had tachycardia, and analysis revealed a decreased partial pressure of oxygen. He then developed frothy pink secretions from the endotracheal tube. Noncardiogenic pulmonary oedema was diagnosed. On completion of surgery, the man received morphine, diazepam and furosemide. He was then transferred to an ICU, where ventilation was continued. Chest x-ray findings were consistent with pulmonary oedema. His chest x-rays and oxygenation gradually improved, and he was extubated the following morning. He remained under observation in the ICU for 3 days. Author comment: "The only possibility seems to be [antithymocyte globulin]. Pulmonary edema developed at the time of completion of [antithymocyte] infusion probably due to administration of [antihistamines] and steroids during surgery." Parikh BP, et al. Anti-thymocyte globulin induced non-cardiogenic pulmonary edema during renal transplantation. Indian Journal of Critical Care Medicine 15: 230-232, No. 4, Oct-Dec 2011. Available from: URL: http:// 803068827 dx.doi.org/10.4103/0972-5229.92076 - India
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Reactions 7 Apr 2012 No. 1396
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