Unexpected death due to cefuroxime-induced disulfiram-like reaction
A 64-year-old Chinese male went into a rural out-patient with clinical history of chronic tracheitis and emphysema. The patient is a known smoker since 30 years. The patient was prescribed cefuroxime sodium 4.5 g infusion and 5% glucose in 250-ml saline. After the patient got one-third infusion of Cefuroxime sodium in general frequency, the doctor noticed that the patient presented with facial flushing, sweating, and weakness. The patient had a blood pressure of 95/60 mmHg and pulse of 110/min on examination. The patient had dyspnea and lost consciousness very soon, and died later despite of the resuscitation attempts. He already had received the same treatment for 2 days because of cough and expectoration. The investigation indicated that the patient had taken alcohol before he went to the clinic that day.\nAutopsy was carried out. There was mild to moderate eccentric atheroma detected in left anterior descending coronary artery and left circumflex, which caused <40% stenosis of vessel lumen. Low-grade emphysematous-like changes were seen in both the lungs. Microscopically, over-inflated alveoli and the lymphocytic infiltration in the submucous layer of the bronchial wall were also seen. A few eosinophilic granulocytes were present in the submucosal layer of the larynx, but not in other organ sections. Other organs were unremarkable on macro and microscopic examination.\nToxicological analysis of heart blood revealed elevated serum ethanol (2110 mg/L) and acetaldehyde (60 mg/L). Total IgE was 85.47 IU/ml (normal reference ranges: 1.31-165.30 IU/ml). Disulfiram-like reaction induced by cefuroxime sodium interacting with alcohol was identified as the cause of death, and coronary artery disease was likely to contribute to the patient's death.