Back to Journals » Drug, Healthcare and Patient Safety » Volume 8

A fatal adverse effect of cefazolin administration: severe brain edema in a patient with multiple meningiomas

Authors Tribuddharat S, Sathitkarnmanee T, Kitkhuandee A, Theerapongpakdee S, Ngamsangsirisup K, Chantawong S

Received 1 July 2015

Accepted for publication 18 December 2015

Published 9 February 2016 Volume 2016:8 Pages 9—12


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Boyang Bian

Peer reviewer comments 3

Editor who approved publication: Professor Chul Ahn

Sirirat Tribuddharat,1 Thepakorn Sathitkarnmanee,1 Amnat Kitkhuandee,2 Sunchai Theerapongpakdee,1 Kriangsak Ngamsaengsirisup,1 Sarinya Chanthawong,1

1Department of Anesthesiology, 2Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Cefazolin is commonly administered before surgery as a prophylactic antibiotic. Hypersensitivity to cefazolin is not uncommon, and the symptoms mostly include urticaria, skin reaction, diarrhea, vomiting, and transient neutropenia, which are rarely life threatening. We present a rare case of fatal cefazolin hypersensitivity in a female who was diagnosed with multiple meningiomas and scheduled for craniotomy and tumor removal. Immediately after cefazolin IV administration, the patient developed acute hypertensive crisis, which resolved within 10 minutes after the treatment. This was followed by unexplained metabolic acidosis. The patient then developed severe brain edema 100 minutes later. The patient had facial edema when her face was exposed for the next 30 minutes. A computed tomography scan revealed global brain edema with herniation. She was admitted to the intensive care unit for symptomatic treatment and died 10 days after surgery from multiorgan failure. The serum IgE level was very high (734 IU/mL). Single-dose administration of cefazolin for surgical prophylaxis may lead to rare, fatal adverse reaction. The warning signs are sudden, unexplained metabolic acidosis, hypertensive crisis, tachycardia, and facial angioedema predominating with or without cutaneous symptoms like urticaria.

cefazolin, adverse effect, drug hypersensitivity, brain edema, hypertension

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Other articles by this author:

Comparative study of minimal fresh gas flow used in Lack-Plus and Lack’s circuit in spontaneously breathing anesthetized adults

Theerapongpakdee S, Sathitkarnmanee T, Tribuddharat S, Sucher S, Thananun M, Nonlhaopol D

Medical Devices: Evidence and Research 2016, 9:395-399

Published Date: 8 November 2016

1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous oxide

Sathitkarnmanee T, Tribuddharat S, Nonlhaopol D, Thananun M, Somdee W

Drug Design, Development and Therapy 2015, 9:977-981

Published Date: 17 February 2015

Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial

Sathitkarnmanee T, Tribuddharat S, Noiphitak K, Theerapongpakdee S, Pongjanyakul S, Huntula Y, Thananun M

Journal of Pain Research 2014, 7:449-454

Published Date: 1 August 2014

Readers of this article also read:

The virgin land of quality management: a first measure of patient safety climate at the National Hospital of the Faroe Islands

Kristensen S, Túgvustein N, Zachariassen H, Sabroe S, Bartels P, Mainz J

Drug, Healthcare and Patient Safety 2016, 8:49-57

Published Date: 26 April 2016

Seasonality in acute liver injury? Findings in two health care claims databases

Weinstein RB, Schuemie MJ, Ryan PB, Stang PE

Drug, Healthcare and Patient Safety 2016, 8:39-48

Published Date: 31 March 2016

Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia

Bhusal S, Diomampo S, Magrey MN

Drug, Healthcare and Patient Safety 2016, 8:13-23

Published Date: 17 February 2016

Benefit–risk assessment of golimumab in the treatment of refractory ulcerative colitis

Pugliese D, Felice C, Landi R, Papa A, Guidi L, Armuzzi A

Drug, Healthcare and Patient Safety 2016, 8:1-7

Published Date: 3 February 2016

Clinical utility of tadalafil in the treatment of pulmonary arterial hypertension: an evidence-based review

Henrie AM, Nawarskas JJ, Anderson JR

Core Evidence 2015, 10:99-109

Published Date: 2 November 2015

Association of FTO and PPARG polymorphisms with obesity in Portuguese women

Ferreira Carlos F, Silva-Nunes J, Flores O, Brito M, Doria G, Veiga L, Baptista PV

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2013, 6:241-245

Published Date: 11 July 2013

Antipsychotic agents: efficacy and safety in schizophrenia

de Araújo AN, de Sena EP, de Oliveira IR, Juruena MF

Drug, Healthcare and Patient Safety 2012, 4:173-180

Published Date: 29 November 2012