Hypersensitivity and cross-reactivity to cisplatin and carboplatin

Cisplatin was the first of the platinum drugs. Second-generation platinum derivative
was carboplatin that its efficacy in the treatment of many malignancies is equal to
cisplatin, and its toxicity profile is more favorable. Here we report on a 50-year-old
woman with a history of cervix cancer who developed a severe hypersensitivity reaction
(HSR) to carboplatin. She was admitted to the emergency department (ED) with
shortness of breath, tachypnea, restless, agitation, and lethargy. On arrival, the patient
was hemodynamically unstable; we initiated treatment immediately with hydration,
oxygen therapy with mask, hydrocortisone, midazolam, and adrenalin. After 1 hour, BP
and O
2 sat improved to 100/70 mm Hg and 92% respectively, but there was not any
significant improvement in tachycardia as well as tachypnea and she was still lethargic
and agitated. Her symptoms improved gradually after 18 hours of admission. She was
discharged after 36 hours. HSRs to cisplatin and carboplatin can be potentially lifethreatening. The symptoms can range from a mild rash to severe anaphylaxis. Doctors
should be aware of these reactions, determine appropriate treatment, and know the
cross-reactivity among these drugs.