Anaphylactic Shock Caused by Talc Pleurodesis Performed for
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A 69-year-old woman was referred for a lung tumor discovered during a medical checkup. The 8.5-cm tumor was located in the right upper lobe, and it was classified as clinical stage T1a N0 M0.

The author performed video-assisted thoracic surgery for partial resection of the right upper lobe. Because the frozen-section diagnosis showed small cell lung carcinoma, they also performed upper lobe lobectomy and lymph node dissection. The patient had persistent postoperative air leakage, which diminished but was still present on a postoperative day (POD) 6. To shorten the hospital stay, the author performed pleurodesis on POD 7 by using 4 g of large-particle talc and 50 mL of saline solution (with a local anesthetic). Just after talc administration into the thoracic cavity, the patient reported nausea and dyspnea and they observed stridor, systemic urticaria, and facial flushing.

Her blood pressure was 61/44 mm Hg, her heart rate was 100 beats/min, and her blood oxygen saturation as measured by pulse oximetry was 78%. they immediately treated her for talc-related anaphylactic shock. The aithor administered an intramuscular injection of epinephrine and intravenous injection of methylprednisolone. Simultaneously, thoracic drainage was started with 20 cm H2O suction to drain talc from the thoracic cavity. Shock resolved a few minutes after treatment. Because the patient’s respiratory status had recovered by this time and a chest roentgenogram showed no infiltration, ruled out ARDS. Postpleurodesis laboratory values were normal. On POD 8 author started a 3-day course of betamethasone at 2 g daily to prevent a delayed-type allergic reaction.

Source:https://www.sciencedirect.com/science/article/pii/S0003497520309784?dgcid=rss_sd_all
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