What happened, in summary

A 54-year-old woman with ductal carcinoma in situ of the left breast was scheduled for sentinel lymph-node assessment and mastectomy followed by reconstruction. Five minutes after 1 mL of patent blue dye was injected under the skin, she developed oxygen desaturation, tachycardia, hypotension, a blue skin eruption and neck swelling.

The operation was stopped. Her hypotension lasted about 40 minutes and required epinephrine, hydrocortisone, antihistamine treatment and intravenous fluids. She was admitted to intensive care and also developed a pneumothorax, thought to be related to difficult intubation.

Allergy testing later excluded several other perioperative drugs and materials. Patent blue produced a positive skin-prick test, and methylene blue was also positive on intradermal testing, supporting an IgE-mediated dye allergy with possible cross-reactivity.

Because the breast operation still needed to proceed, she was reoperated without blue dyes. Sentinel-node mapping was performed using 99mTc albumin nanocolloid, while the other drugs from the original procedure were used again. The repeat operation was completed without another allergic reaction. The repeat surgery allowed her breast-cancer operation to proceed without another allergic reaction.