All cats are gray in the dark or: not all NSAIDs give adverse reactions. A case report.

Background: Intolerance to acetylsalicilic acid (ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) is a crucial problem in medical practice. The prevalence of NSAIDs intolerance is estimated as 0.6–2.5 in the general population, rising to over 10–20% in asthmatic patients. In general practice, NSAIDs are always supposed to cross-react with each other. Because the use of ASA as platelet antiaggregant is mandatory in many cardiological diagnostic and therapeutic procedures, ASA intolerance is a common and a severe problem in Coronary Intensive Care Unit (CICU). Here we describe the case of a Diclofenac intolerant patient who tolerates ASA treatment without any reaction. Case Report: A 57 years old male patient, affected with mild hypertension and osteoarthritis suffered a severe anaphylaxis after the application of a Diclofenac suppository. A few minutes after the drug application he had symptoms of glottis oedema and rapidly fell unconscious. The rescue team found him pulseless. He underwent to resuscitation procedures with success. Then, he was admitted into the CICU and the tests performed there showed: nonspecific, diffused alterations of the repolarization (DII, DIII; V3-V6) at the electrocardiogram; a mild increment of troponine I (maximum 3.17 mg/L); no pathological findings at the echocardiography. The ventricular coronarography showed a 95% stenosis of a collateral vessel of the right coronary artery that underwent to a successful placement of a drug-eluting stent. Chest X-Ray, ultrasound scans of the abdomen and of the chest, and brain Computer Tomography were normal. When he was in CICU he was started on therapy with ASA 100 mg daily under medical control. He tolerated ASA without any complication during all the eleven days of hospitalization. The allergy consultant suggested to avoid stopping the therapy with ASA and to avoid taking Diclofenac, Aceclofenac and any other NSAIDs, apart from paracetamole in the future. This case demonstrates that patients with severe Diclofenac hypersensitivity could tolerate other NSAIDs, in particular ASA, mandatory in some medical procedures. Other authors (1) described tolerance of indomethacin, piroxicam, methamizole but not ASA in 12 Diclofenac hypersensitive patients. Conclusion: In conclusion, patients referring previous reactions to NSAIDs should not be a priori excluded from treatment requiring ASA.