Correspondence
Acute Reaction to Dipyridamole during Myocardial Scintigraphy
N Engl J Med 1999; 340:394February 4, 1999
- Article
To the Editor:
We report an acute allergic reaction to an infusion of dipyridamole. A 56-year-old man was referred for myocardial scintigraphy. He had no history of asthma or diabetes mellitus. His medications included atenolol and gemfibrozil. He had a history of allergy to aspirin, tetracycline, and penicillin. His reactions included angioedema and dyspnea.
Dipyridamole stress testing was used because the patient had a left bundle-branch block. Approximately one minute after the infusion was started, the patient reported periorbital pruritus, but his condition was otherwise stable. The infusion was completed uneventfully with the administration of technetium-99m sestamibi at seven minutes.
Twenty minutes later, the patient had tightness in the neck, dyspnea, and generalized facial swelling. After the administration of oxygen, he was transferred to the emergency department in stable condition. Since his reaction had progressed slowly, epinephrine was withheld, and intravenous promethazine hydrochloride and hydrocortisone were administered. The patient's condition improved over the next two hours, with residual periorbital edema but complete recovery from the respiratory symptoms. The cardiac study was completed without further events. The result was normal.
A previous report of an acute reaction to dipyridamole1 noted a florid reaction within 45 seconds after the infusion had been started. Erythema, urticaria, facial swelling, and dyspnea developed rapidly, requiring intravenous epinephrine and dexamethasone. The only similarity between the cases was the patients' use of beta-blockers, which have been reported to increase the incidence of reactions to radiologic contrast medium.2 Our patient had a less severe course. He reported that he had not had any previous exposure to dipyridamole or technetium-99m sestamibi.
It is unlikely that this reaction was due to the administration of technetium-99m sestamibi because of the temporal course of the events, with no reaction in the two hours after the initial injection of technetium-99m sestamibi. A reaction to the second postdipyridamole injection of technetium-99m sestamibi would have been unlikely on the basis of sensitization to the first injection, since only two hours had elapsed between exposures. Furthermore, the facial pruritus coincided with the infusion of dipyridamole. It should be noted that reactions such as these to dipyridamole, although of obvious concern, appear to be exceedingly rare.
2 ReferencesS. Angelides, M.B., B.S.
H. Van der Wall, M.B., B.S., Ph.D.
S.B. Freedman, M.B., B.S., Ph.D.
Concord Hospital, Concord 2139, Australia1
Weinmann P ,Moretti JL ,Leynadier F . Anaphylaxis-like reaction induced by dipyridamole during myocardial scintigraphy. Am J Med 1994;97:488-488
CrossRef | Web of Science | Medline2
Lang DM ,Alpern MB ,Visintainer PF ,Smith ST . Increased risk for anaphylactoid reaction from contrast media in patients on β-adrenergic blockers or with asthma. Ann Intern Med 1991;115:270-276
Web of Science | Medline
- Citing Articles (5)
Citing Articles
1
Wanzhen Zeng, Steven Glassman, Mary Dalipaj, Terrence Ruddy. (2010) Cutaneous drug eruption from aminophylline use during dipyridamole nuclear stress testing. Journal of Nuclear Cardiology 17:5, 934-936
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2006. Dipyridamole. , 1140-1142.
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M. Muschen, K. Rajewsky, A. Brauninger, A. S. Baur, J. J. Oudejans, A. Roers, M.-L. Hansmann, R. Kuppers. (2000) Rare Occurrence of Classical Hodgkin's Disease as a T Cell Lymphoma. Journal of Experimental Medicine 191:2, 387-394
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U. Hasse, M. Tinguely, E. O. Leibundgut, J.-F. Cajot, A. M. Garvin, A. Tobler, B. Borisch, M. F. Fey. (1999) Clonal Loss of Heterozygosity in Microdissected Hodgkin and Reed-Sternberg Cells. JNCI Journal of the National Cancer Institute 91:18, 1581-1583
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&NA;. (1999) Dipyridamole. Reactions Weekly &NA;:738, 7
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