Oxaliplatin Induced Severe Hypoxemia, Chills and Hypersensitivity Reaction

Hypersensitivity reactions to platinum containing compounds are well described and potentially life threatening. The hypersensitivity reactions can occur either during, or shortly after the infusion of drug. The incidence increases with increase in the number of chemotherapy cycles. Hypersensitivity reactions can vary from mild reactions like rashes to severe reactions, which include laryngospasm, tachycardia, hypotension or hypertension. The combination of 5-flurouracil, leucovarin and oxaliplatin has been used in several studies to increase survival rates and reduce the risk of disease progression in patients with metastatic colorectal cancer (CRC) and stage III colon cancer. We report a case of patient treated with oxaliplatin who developed Severe Grade-III Toxicity including Hypoxemia, Chills and hypersensitivity reaction like rashes all over the body with itching sensation about few hrs after the oxaliplatin infusion. Patient tolerated 7 cycles of FLOT chemotherapy well. During cycle 8 chemotherapy after 50% infusion of oxaliplatin patient developed severe reaction to oxaliplatin such as breathlessness, shivering, hypersensitivity reaction like rashes all over the body and itching sensation. The drug infusion was stopped immediately, vitals were checked which shows BP: 170/110mmhg, Temperature 100⁰F, Spo2 85% RA. It was confirmed as grade 3 toxicity of oxaliplatin.  The adverse drug reaction assessment was done using Naranjo’s causality assessment scale which showed ‘definite’ type of adverse drug reaction with oxaliplatin.  Prompt recognition of this event and symptomatic treatment with supplemental oxygen and corticosteroids and prolonging the infusion time of oxaliplatin can lead to better patient compliance and lesser hypersensitivity reactions to these regimens. Keywords: Oxaliplatin, Colorectal cancer (CRC), Dyspnoea, Hypersensitivity reactions, Chemotherapy.