アナフィラキシーショックがメシル酸ナファモスタットで誘発された長期維持透析患者の1例

Abstract

We observed a case of anaphylaxis which was induced by the injection of nafamostat masilate in a patient undergoing long-term maintenance of hemodialysis. The 62-year-old male had been receiving hemodialysis for 20 years because of chronic glomer- ulonephrits. This patient also suffered from renal osteodystrophy for the last 3 years, and had undergone 5 operations for bone fracture or carpal tunnel syndromes. During surgery, nafamostat masilate was used instead of heparin sodium to avoid bleeding, and no problems occurred with respect to continuation of hemodialysis. However, anaphylaxis appeared during injection of nafamostat masilate at a dental extraction on April 17 and accompanying a thigh contusion with hematoma on August 23, 1996. The anaphylaxis was clinically more severe on August 23. The results of a lymphocyte stimulation test for nafamostat masilate were positive. There were no other factors present that might have induced hypotension (heart failure, antihypertensive drug therapy, anemia, inappropriate dry weight, etc.).We therefore report this as a case of acquired allergy to nafamostat masilate during long-term maintenance of hemodialysis.