A case of anaphylactic shock possibly caused by intravesical Hexvix ®

Background:  We report a case of a 69‐year‐old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix ® ). Incident:  A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix ® . There was an increase in serum tryptase (almost nine‐fold) and a positive skin prick test to undiluted Hexvix ® . Conclusion:  The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non‐immunoglobulin E‐mediated allergic reaction possibly caused by Hexvix ® . This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix ® .