Gadobutrol

Abstract

Acute respiratory distress syndrome secondary to anaphylaxis: case report A 47-year-old woman developed acute respiratory distress syndrome secondary to anaphylaxis following the administration of gadobutrol as a contrast agent. The woman presented to the emergency department (ED) for acute shortness of breath and cyanosis of the lips. She had an MRI of the breast with IV gadobutrol [gadovist] 7 milliliters carried out in the outpatient clinic two hours prior to her presentation to the ED. When she arrived in the ED, she was short of breath on exertion and at rest. She felt nauseous, mild distress, was dizzy and was observed to have bilateral rales on examination. Her fist vital signs showed BP of 118/70mm Hg, heart rate of 128 beats/minute, a temperature of 94.9° F, respiratory rate of 26 and oxygen saturation of 96% . The woman received diphenhydramine and methylprednisolone with partial relief. In the ED, her repeat saturating pulse oxygen was 80% on 3-liter/minute oxygen supplementation. The chest X-ray showed bilateral diffuse ground glass opacities. Subsequently, she was kept on bilevel positive airway pressure (BiPap) machine for 1 hour in the ED for symptomatic relief. But, she continued to be hypoxic, tachypneic and was hypotensive. Thereafter, she had to be intubated and kept on mechanical ventilation because of worsening respiratory status and received epinephrine drip. Subsequently, she was diagnosed with acute respiratory distress syndrome secondary to anaphylaxis associated with gadobutrol [duration of treatment to reactions onset not stated]. She was afebrile through her hospital stay. Thereafter, she was placed on epinephrine drip for approximately 12 hours and then weaned off. She got extubated eventually on day 4 of the hospital stay and then got discharged on day 7 with epinephrine pen.