Perioperative management of a patient with multiple drug hypersensitivity syndrome

Patients with multiple drug hypersensitivity often pose significant challenge during surgery because of the greater risk of developing anaphylactic shock that could be fatal. The use of novel pharmaceutical agents such as anesthetic drugs and medical devices made from a wide range of chemicals and materials with unknown antigenicity potentially predisposes this subset of patients to hypersensitivity reactions in the perioperative period. The authors encountered a 20-year-old patient with a history of multiple drug hypersensitivities, who had been diagnosed with a huge ovarian tumor. She underwent surgery successfully but faced a rather difficult recovery. Herein, we discuss the management of unexpected perioperative outcomes with the support of literature review. This article also highlights the use of drug provocation tests and the necessary precautions to be taken in the absence of standardized preoperative guidelines for patients with multiple drug hypersensitivity syndrome undergoing major surgical procedures.