Chlorhexidine gluconate (CHG) is a topical antiseptic and surgical scrub increasingly implicated in periprocedural anaphylaxis. We present four patients who had anaphylaxis in the setting of CHG exposure, an agent that has been increasingly implicated in periprocedural anaphylaxis. Catheters can be impregnated with CHG and overlooked as a source of exposure resulting in anaphylaxis.

Tongue Necrosis as a Manifestation of Immune Dysfunction: A Complex Case of Lupus, Histoplasmosis, and Macrophage Activation SyndromeMadalyn Walsh, MD1, Alick Feng, MD2, Petar Lenart, MD PhD2, Bharat Kumar, MD MME21Department of Internal Medicine, University of Iowa Hospitals & Clinics2Division of Immunology, University of Iowa Hospitals & Clinics

Introduction Zanubrutinib is a second generation Bruton’s tyrosine kinase inhibitor (BTKi) often used to treat B cell malignancies such as marginal zone lymphoma. BTKis belong to a protein tyrosine kinase family that plays an essential role in the proliferation, differentiation, and survival of B cells. The side effects of BTKis include infection, diarrhea, skin rash, and atrial fibrillation. Invasive fungal infections have been previously described with Ibrutinib (a first generation BTKi) but seldom with second generation BTKis such as zanubrutinib.