A Case of Refractory Anaphylactic Shock During Coronary Interventional Therapy

Background Refractory anaphylactic shock is a complex and critical research domain in the fields of allergy and immunology. It is defined as anaphylaxis that is unresponsive to the standard treatment of intramuscular epinephrine injection, and is associated with increased mortality in patients. This article reports a case of refractory anaphylactic shock occurring during coronary interventional therapy, detailing the management process—from pharmacological resuscitation and endotracheal intubation to the resolution of the allergic storm and subsequent complications—thereby enhancing the understanding of its clinical management. Case Presentation: A 53-year-old Chinese male patient, who had prior stenting to left anterior descending artery (LAD) and intermediate branch 1 months ago causing by Acute myocardial infarction, was admitted on October 13, 2024, for a scheduled percutaneous coronary intervention .One month ago, The surgery was successful, and there were no allergic reactions, such as skin itching or rashes, after the operation. And he developed refractory anaphylactic shock during the secondary operation, which was unresponsive to the intramuscular epinephrine injection. Finally, 30 mg epinephrine, 40 mg norepinephrine, 280 mg methylprednisolone, 10 mg dexamethasone, 750 ml sodium bicarbonate, 4 mg atropine, 30 mg dopamine, more than 10 cycles of defibrillation, approximately 7500 ml saline, 500 ml low-molecular-weight dextran, Oral tracheal intubation and continuous chest compressions were performed, and the patient was stable on discharge after two weeks later. Conclusion This is a case report of a refractory anaphylactic shock.Detailing the management process—from pharmacological resuscitation and endotracheal intubation to the resolution of the allergic storm and subsequent complications—thereby can enhance the understanding of its clinical management.