Muhammad Sohaib, MD1, Ahmad Zain, MBBS2, Muhammad Shammas Tariq, MBBS3, Fatima Zia, MD4, Sara Ahmed, MD5, Zainab Zia, MD6, Muhammad Hamza, MD7 1UCHealth Parkview Medical Center, Pueblo, CO; 2Parkview Medical Center, Pueblo, CO; 3Jinnah Hospital Lahore, Lahore, Punjab, Pakistan; 4Army Medical College, Rawalpindi, Pakistan, Pace, FL; 5Shalamar Medical and Dental College, Pakistan, Lahore, Punjab, Pakistan; 6Karachi Institute of Medical Sciences, Karachi, Pakistan, Pueblo, CO; 7Aga Khan University, Lahore, Punjab, Pakistan Introduction: Proton pump inhibitors (PPIs) are among the most widely prescribed medications for acid-related gastrointestinal disorders. Although generally well-tolerated, they are increasingly recognized as potential culprits in severe hypersensitivity reactions. This case highlights a rare presentation of pantoprazole-induced anaphylactic shock.
Case Description/
Methods: An 81-year-old female presented with intractable nausea and vomiting. Abdominal CT imaging revealed proximal gastric wall thickening, prompting consideration for esophagogastroduodenoscopy (EGD). She was started on intravenous pantoprazole for symptom management. Within 24 hours, the patient developed a diffuse erythematous skin rash, high-grade fevers, and hypotensive shock requiring vasopressor support despite aggressive fluid resuscitation. Infectious workup, including blood and urine cultures and chest imaging, was unrevealing. With no identifiable infectious source and a temporal relationship to pantoprazole initiation, a diagnosis of drug-induced hypersensitivity reaction was suspected. Pantoprazole was discontinued, resulting in rapid clinical improvement and resolution of hemodynamic instability. The skin rash gradually resolved without further intervention. EGD was later performed and was unremarkable. The patient was discharged in stable condition, and pantoprazole was documented as an allergic medication in her medical record. Discussion: PPI-induced hypersensitivity reactions can present with a spectrum ranging from mild rash to life-threatening anaphylaxis or shock. Diagnosis is often clinical and hinges on the exclusion of other causes, particularly sepsis. Early recognition and withdrawal of the offending agent are critical for rapid recovery and prevention of further complications. Different PPI’s may carry varying risks and severities of adverse effects. Clinicians should be wary of these side effects and avoid prescribing them to patients with a history of hypersensitivity to pantoprazole or related compounds. Further research is needed to understand the short and long-term effects of PPI use.
Disclosures: Muhammad Sohaib indicated no relevant financial relationships. Ahmad Zain indicated no relevant financial relationships. Muhammad Shammas Tariq indicated no relevant financial relationships. Fatima Zia indicated no relevant financial relationships. Sara Ahmed indicated no relevant financial relationships. Zainab Zia indicated no relevant financial relationships. Muhammad Hamza indicated no relevant financial relationships.
Muhammad Sohaib, MD1, Ahmad Zain, MBBS2, Muhammad Shammas Tariq, MBBS3, Fatima Zia, MD4, Sara Ahmed, MD5, Zainab Zia, MD6, Muhammad Hamza, MD7. P4243 - The Pill That Pushed Too Far: A Shocking Reaction, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
