Emergency management and nursing care of a patient with moxifloxacin-induced anaphylactic shock complicated with Takotsubo syndrome

Abstract

Abstract Background Takotsubo syndrome (TTS) is an acute cardiac condition marked by reversible left ventricular dysfunction, with clinical features that resemble acute coronary syndrome but occur without significant coronary artery stenosis. Its development is strongly linked to catecholamine-mediated toxicity. Inflammatory mediators released during allergic responses may further amplify catecholamine secretion; however, drug-induced anaphylactic shock accompanied by TTS has only been rarely documented. Case Presentation A 31-year-old female experienced simultaneous anaphylactic shock and TTS (EF 31%) after receiving intravenous moxifloxacin. Emergency management involved adrenaline, corticosteroids, and antihistamines, together with PICCO-guided circulatory support (target MAP ≥ 65 mmHg) and combined antiplatelet/anticoagulant therapy. A family-based “3-min emergency response” training program and a graded rehabilitation protocol were carried out. Before discharge, ADRB1 genetic testing was completed, which identified the GG genotype, and beta-blocker treatment was then started accordingly. The patient’s EF increased to 45% within 48 h, recovered completely within 10 days, and remained stable throughout 6-month pregnancy follow-up under multidisciplinary care, including dynamic EF monitoring ≥ 55% and anticoagulant adjustment. Conclusion Moxifloxacin may contribute to TTS through allergic-sympathetic pathways, making careful recognition of overlapping symptoms necessary. Important approaches for lowering recurrence risk include family training, gene-guided therapy, and multidisciplinary cooperation. This study offers useful insight into the care of drug-related TTS, highlighting the need for allergy assessment before drug administration and continued follow-up care. This study was approved by the Medical Ethics Committee of Zhejiang Provincial Tongde Hospital (Ethics Approval No: 2025-Research-069), and the patient provided written informed consent for the use of anonymized case data for academic research. Clinical trial number MR-33-25-027765.