PD157 - CASE REPORT: HYPERSENSITIVITY TO MULTI-CHAMBERED PARENTERAL NUTRITION

PD157

CASE REPORT: HYPERSENSITIVITY TO MULTI-CHAMBERED PARENTERAL NUTRITION

A. Vasle^1,*, K. Berlec¹, K. Kogovšek¹, T. K. Božič^1,2, M. Lubej³, M. Majerr¹, L. Puzigaća¹, Š. Urh³, N. R. Kozjek^1,2

¹Department of Clinical Nutrition and Intestinal Failure, Institute of Oncology, ²Faculty of Medicine, University of Ljubljana, ³Pharmacy, University Clinical Centre Ljubljana, Ljubljana, Slovenia

Rationale: Hypersensitivity to parenteral nutrition (PN) is rare but clinically significant, particularly in patients requiring long-term therapy. This case highlights the value of structured elimination and systematic re-challenge in suspected reactions to PN.

Methods: A 63-year-old female with chronic intestinal failure, sarcopenia, cachexia, chronic pancreatitis, duodenal stenosis, parenchymal liver disease with portal hypertension, and prior breast cancer required long-term home PN. In 2024, she developed a pruritic erythematous rash shortly after PN infusion that resolved after PN discontinuation and electrolyte-only infusions. Despite a documented beta-lactam allergy, allergy testing was negative.

Results: During hospitalization in January 2025, elimination and component re-challenge were performed. Hypersensitivity with rash recurred with various commercial multi-chamber PN despite high-dose antihistamines, while isolated lipid emulsions, amino acids, vitamins, and trace elements were tolerated. Causality assessment yielded a Naranjo score of 7 (''Probable''), and the Liverpool Causality Assessment Tool indicated ''definite'' causality. A pharmacist-compounded all-in-one PN using individually tested components was introduced and well tolerated. The patient was discharged on this regimen without further reactions. PN hypersensitivity is rare: a 2018 systematic review identified 33 cases across 28 publications. Cutaneous reactions were most common, with lipid emulsions (48.4%), multivitamins (33.3%), and amino acids (9%) most frequently implicated. In a minority of cases (6%), the allergen could not be identified and was limited to a few components.

Conclusion: We present a rare, first Slovenian case of persistent hypersensitivity specific to commercial multi-chamber PN despite tolerance to individually administered nutrients, suggesting excipient or component interactions. Pharmacist-compounded PN provided a safe long-term alternative.

Disclosure of Interest: None declared