Successful management of protracted anaphylaxis-induced severe acute respiratory distress syndrome masquerading as non-ST elevation myocardial infarction: a rare case report

BACKGROUND: Prolonged anaphylaxis, especially symptoms that last several days, can lead to misdiagnosis and delays in treatment, especially when patients present with complications such as acute respiratory distress syndrome (ARDS) and secondary myocardial injury. A thorough review of medical history is very important for accurate diagnosis. Early recognition and intervention are essential for managing both the allergic response and pulmonary-cardiac injury. CASE PRESENTATION: We present the case of a 70-year-old woman with no significant medical history who developed rapid respiratory failure and extremely elevated troponin levels. The patient was initially diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by pulmonary edema, and the patient's condition continued to worsen despite coronary intervention. A reevaluation revealed that anaphylaxis was potentially triggered by the recent use of floctafenine and meloxicam, which were taken as painkillers four days before admission. The administration of epinephrine led to a marked improvement in her condition, and she was successfully discharged without further complications. CONCLUSION: Protracted anaphylaxis, especially when complicated by ARDS and myocardial injury mimicking NSTEMI, requires careful diagnostic consideration. Clinicians must thoroughly evaluate patient history, particularly recent medication use, to avoid misdiagnosis. Epinephrine remains a crucial treatment in such cases, and prompt administration can be life-saving. This case highlights the diagnostic challenges of protracted anaphylaxis and the importance of comprehensive clinical assessment and timely intervention.