title: Severe abdominal pain associated with allergic reaction to nafamostat mesilate in a chronic hemodialysis patient.
abstract: A 33-year-old woman was referred from an outside dialysis clinic to our hospital because of severe abdominal pain during hemodialysis. She had been on chronic hemodialysis for the past 11 years due to chronic glomerulonephritis. Nafamostat mesilate was used as an anticoagulant for hemodialysis, because it was during her menstrual period with hypermenorrhea. On admission, she had no abdominal pain or gynecological abnormalities. On the second day, she had similar abdominal pain during hemodialysis with nafamostat mesilate in our dialysis unit. The abdominal pain disappeared within 60 minutes after discontinuing the hemodialysis. We re-started dialysis using heparin instead of nafamostat mesilate and she had no symptoms. The titer of total immunoglobulin E was high. The drug lymphocyte stimulation test was positive for nafamostat mesilate and antigen specific immunoglobulin E to nafamostat mesilate was highly positive in her blood. Although an allergic reaction to nafamostat mesilate is a rare complication, it should be one of the differential diagnoses of abdominal pain occurring during hemodialysis.
authors.affiliation: Third Department of Internal Medicine, University of the Ryukyus, School of Medicine, Okinawa.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamazato
authors.forename: Rieko
authors.initials: R
authors.lastname: Mano
authors.forename: Saori
authors.initials: S
authors.lastname: Oshiro-Chinen
authors.forename: Nozomi
authors.initials: N
authors.lastname: Tomiyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakima
authors.forename: Akio
authors.initials: A
authors.lastname: Ishida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tana
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tozawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Muratani
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Shuichi
authors.initials: S
authors.lastname: Takishita
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D001550:Benzamidines; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000628:therapy; D005260:Female; D005341:Fibrinolysin / Q000037:antagonists & inhibitors; D005921:Glomerulonephritis / Q000628:therapy; D006146:Guanidines / Q000009:adverse effects*; D006437:Hemodialysis, Home / Q000009:adverse effects; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008213:Lymphocyte Activation / Q000502:physiology
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; D007073:Immunoglobulin E; D005341:Fibrinolysin; C032855:nafamostat