carboplatin is frequently used in patients with ovarian cancer , in second - line or salvage settings . serious hypersensitivity reactions due to carboplatin have been previously described [ 2 , 3 , 4 , 5 , 6 ] . carboplatin toxicity normally develops after more than 5 or 6 cycles of treatment ; however , previous studies were able to show that patients have developed toxicity during their initial therapy or during their second or third treatment . we describe a 65-year - old patient with relapsed ovarian cancer who was treated with carboplatin and developed toxicity during the second cycle . the patient received a 412-mg dose of carboplatin . twenty min after the infusion was started , the patient developed dyspnea , wheezing , hypotension and confusion . her blood pressure was 90/40 mm hg , saturation 78% in room air , pulse rate 140 bpm and breath rate 34 breaths / min . the infusion was stopped and our patient was transferred to the intensive care unit ( icu ) . she was intubated due to respiratory failure , and adrenaline , fluids and corticosteroids were infused . cardiac ultrasound was performed and acute coronary syndrome was excluded by ecg and troponin i. pulmonary embolism was ruled out by a spiral ct scan of the lungs . pulmonary capillary wedge pressure and central venous pressure were 4 and 3 mm hg , respectively . blood and urine cultures were negative , rapid abdomen ultrasound was normal and a brain ct scan was without findings . six days after icu admission , the patient developed fever and ventilator - associated pneumonia was diagnosed . recent studies have suggested that reactions develop due to a type i response mediated by the release of histamine and cytokines as well as the involvement of a type iv reaction with t cell - mediated production of cytokines [ 8 , 9 ] . our patient developed hypotension , wheezing with respiratory failure and dyspnea during the second course of carboplatin administration , 20 min after the infusion was started . this led us to conclude that carboplatin induced a hypersensitivity reaction in our patient who received this drug due to a relapse of ovarian cancer . serious adverse events normally occur after 56 cycles but can develop earlier , during the first 3 treatment cycles .
we describe a 65-year - old female with relapsed ovarian cancer who developed a severe hypersensitivity reaction during the second cycle of carboplatin treatment . 
 the patient developed respiratory failure , acute respiratory distress syndrome and hypotension , requiring admission to the intensive care unit .