title: A case of anaphylactic shock possibly caused by intravesical Hexvix.
abstract: 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).
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Colapaoli
authors.forename: J
authors.initials: J
authors.lastname: Thorsen
authors.forename: A
authors.initials: A
authors.lastname: Nopp
authors.forename: A B
authors.initials: AB
authors.lastname: Guttormsen
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D000707:Anaphylaxis / Q000209:etiology* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D003558:Cystoscopy; D004342:Drug Hypersensitivity / Q000503:physiopathology*; D005076:Exanthema / Q000139:chemically induced; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D020728:Transurethral Resection of Prostate; D014474:Unconsciousness / Q000209:etiology; D014839:Vomiting
chemical_list: D007073:Immunoglobulin E; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester