S Alballa, A Fatal Case of Aspirin Idiosyncrasy. 1990; 10(5): 576-577 Aspirin is probably the most widely prescribed drug in the world and is present in over four hundred proprietary drugs. It is not an absolutely safe drug and should be taken only for appropriate indications.1 Many side effects have been ascribed to aspirin, probably caused by different mechanisms and with variable incidences. The respiratory side effect is considered an idiosyncratic reaction.2 This term refers to a qualitatively abnormal reaction to a drug that is not due to an allergic mechanism.2 Idiosyncratic reactions are serious but underdiagnosed, 3 and their relationship to aspirin intake may be overlooked if proprietary drugs containing aspirin are used.
Case ReportA 50-year-old Saudi man was admitted to the hospital following a 5-day history of shortness of breath and wheezing. He had had no history of allergy or atopy, but did describe recurrent episodes of nasal discharge, and bronchial asthma had been diagnosed when he was 33 years old. He was not on treatment at the time of admission.Examination revealed bilateral expiratory rhonchi. He also had a nasal polyp on the right side. He was treated with a salbutamol inhaler and intravenously administered aminophylline and was discharged five days later on oral aminophylline. On the day of discharge, when at home, he took two acetylsalicylic acid tablets (aspirin) for headache. A few minutes later he collapsed and was brought to the hospital in a state of respiratory arrest. He was successfully resuscitated and was discharged with the diagnosis of aspirin idiosyncrasy and aspirin-induced asthma. Both the patient and his family were informed about this idiosyncrasy and he was instructed to avoid any aspirincontaining products.Seven months later, he was seen by his general practitioner for a cold and was given Otrivin (xylometazoline hydrochloride) and Sedergine (330 mg of aspirin, 200 mg of ascorbic acid). Within minutes of taking the first dose he collapsed and was brought to the hospital, where on arrival, he was found to be in cardiopulmonary arrest. He was resuscitated and transferred to the intensive care unit. Unfortunately, he remained comatose and brain death was diagnosed.