Abstract
<title>Abstract</title> <p>Background: Perioperative anaphylaxis is a life-threatening emergency that requires immediate recognition and intervention. While corticosteroids are widely used in anesthesia and generally considered safe, immediate hypersensitivity reactions to dexamethasone remain exceptionally rare. In the obstetric setting under spinal anesthesia, diagnosing anaphylaxis is particularly challenging due to overlapping hemodynamic changes associated with neuraxial blockade. Case presentation: A 37-year-old obese primigravida (BMI: 34.0 kg/m²) with severe preeclampsia presented at 32 weeks of gestation with intrauterine fetal death and was scheduled for an emergency Cesarean section. Spinal anesthesia was performed uneventfully using hyperbaric bupivacaine. Immediately following the intravenous administration of 8 mg dexamethasone, the patient acutely developed a generalized maculopapular rash, tachypnea, tachycardia (134 beats/min), severe hypotension (80/37 mmHg), and oxygen desaturation (87%). Acute perioperative anaphylaxis was suspected. Prompt management with high-flow oxygen, intramuscular epinephrine (0.5 mg), aggressive fluid resuscitation, and a norepinephrine bolus led to rapid stabilization, allowing the surgery to proceed safely. A formal allergy workup performed six weeks postoperatively revealed a negative skin prick test (SPT) but a strongly positive intradermal test (IDT) to dexamethasone, confirming a type I IgE-mediated hypersensitivity reaction. Conclusions: This case highlights a rare but critical occurrence of dexamethasone-induced anaphylaxis during Cesarean delivery. Anesthesiologists must maintain a high index of suspicion for anaphylaxis even with drugs traditionally perceived as anti-allergic. Early epinephrine administration is vital, and subsequent postoperative allergy testing is essential to confirm the culprit agent and prevent future life-threatening re-exposure.</p>