Carboplatin hypersensitivity presenting as coronary vasospasm - a case report

Abstract

A 68-year-old female patient with advanced ovarian carcinoma collapsed whilst receiving a carboplatin and cyclophosphamide infusion. This reaction was considered to fit with coronary vasospasm. Hypersensitivity to carboplatin is a rare but real complication of therapy and should be considered in patients presenting with hyperacute changes on ECG whilst receiving carboplatin therapy.

Monitoring of whole-body hyperthermia with transesophageal echocardiography (TEE)

“…idiosyncratic reactions with hypotension have been described [16]. Coronary artery complications using carboplatin are rare but vasospasms have been described [17]. Although cardiac complications were not observed during this study, there is a potential risk of transient cardiac arrhythmias and electrocardiographic signs of myocardial ischemia as reported in five patients in a prospective study including 45 patients undergoing WBH [1].…”

Carboplatin-induced Kounis syndrome

“…At present, only two cases of acute coronary syndrome with ST elevation induced by carboplatin have been reported, one with chest pain as the only clinical presentation [6] and the other with acute shock [7]. Both resolved in a short period and both cases with normal coronaries at angiography were presentations compatible with coronary vasospasm.…”

Successful resuscitation after cardiac arrest secondary to carboplatin infusion: A case report

“…Authors attributed this case to acute coronary syndrome, though no autopsy was performed ( Gadducci et al, 2008 ). They also cited two other instances of coronary vasospasm in response to carboplatin infusion, one in which transient ST segment elevation was noted during the event, but no abnormalities were noted on follow up angiography ( Chasen and Ebrahim, 2002 ), and another in which similar changes were noted on electrocardiogram (ECG) in a lung cancer patient experiencing chest pain during a carboplatin infusion ( Yano and Shimada, 1996 ). An ECG performed after our patient was resuscitated showed sinus tachycardia without ST segment changes, though this does not rule out a transient cardiac event, especially given her pre-existing cardiac comorbidities.…”