Delirium as the Abrupt Manifestation of Severe Anaphylactic Reaction to Oxaliplatin

Hypersensitivity reactions to oxaliplatin, either immediate or delayed-type, has been reported. It may occur in each cycle of infusion but is most common in the 7(superscript th) to 9(superscript th) cycles. Most patients develop allergic events like bronchospasm, rash, angioedema, tachycardia, hypotension, and fever during or just after oxaliplatin infusion. Herein, we report a heavily pretreated colon cancer patient who presented with skin rash and tachycardia after the 7(superscript th) infusion of oxaliplatin. During the next infusion two weeks later, similar symptoms occurred again, accompanied with acute anaphylactic reaction presenting as delirium. Diphenhydramine and anti-inflammatory medication were given promptly, and the patient’s consciousness was regained without any sequela. Oxaliplatin therefore needed to be withheld, and the patient's treatment shifted to another regimen. Infusion-related allergic reaction is rare, but it can be a fatal event. To our knowledge, this is the first presented case with delirium as the first sign of anaphylactic reaction after oxaliplatin infusion. Prompt diagnosis with adequate resuscitation is important. Repeated infusion should be given carefully, and a desensitization protocol might be needed to avoid the same kind of allergic reaction.