Hoigne's syndrome is an acute, non-allergic toxic reaction occurring after the intramuscular injection of aqueous penicillin G procaine. The adverse reaction is specifically attributed to the procaine component, not the penicillin itself.
Understanding Hoigne's Syndrome
This syndrome is a rare but serious complication characterized by a range of neurological and cardiovascular symptoms that arise shortly after injection. It's crucial to differentiate it from a typical allergic reaction to penicillin.
Key Features of Hoigne's Syndrome
- Non-Allergic: Unlike a true allergic reaction, Hoigne's syndrome doesn't involve the immune system.
- Trigger: Caused by the procaine in penicillin G procaine.
- Route of Administration: Occurs after intramuscular injection.
- Rapid Onset: Symptoms appear almost immediately after the injection.
Symptoms
The symptoms of Hoigne's syndrome can be alarming and may include:
-
Neurological:
- Severe anxiety
- Visual and auditory hallucinations
- Seizures
- Confusion
- Fear of impending death
-
Cardiovascular:
- Palpitations
- Tachycardia (rapid heart rate)
- Hypertension (high blood pressure)
These symptoms are transient, typically resolving within minutes to an hour. However, the experience can be extremely frightening for the patient.
Mechanism
The exact mechanism isn't fully understood, but it is thought to involve microembolization of procaine crystals to the pulmonary and cerebral vasculature. This is thought to cause a reaction in the nervous system and circulation, resulting in the observed symptoms.
Treatment
Treatment is primarily supportive and focuses on managing the symptoms. This may include:
- Reassurance and monitoring.
- Oxygen administration if needed.
- Management of seizures if they occur.
Prevention
Preventing Hoigne's syndrome involves careful technique during intramuscular injections. Aspirating before injecting can help prevent inadvertent intravascular injection. Additionally, using alternative antibiotics that don't contain procaine could be considered, especially in patients with a history of anxiety or those prone to adverse reactions.
Hoigne's syndrome is a serious reaction to procaine penicillin that although rare, should be recognised and treated appropriately.
