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1例62岁女性膀胱癌患者术后接受注射用盐酸吡柔比星（吡柔比星）膀胱灌注治疗（吡柔比星30 mg入5%葡萄糖注射液30 ml经导尿管注入膀胱，灌注液保留40 min）。前12次治疗均未发生不良反应。术后7个月进行第13次膀胱灌注约30 min时，患者出现口唇、手脚麻木，大汗淋漓，全身潮红，意识丧失，大小便失禁，血压测不到，心率110次/min，考虑为吡柔比星所致过敏性休克。立即排空膀胱灌注液，予吸氧、抗过敏、强心、升血压治疗1 h后，患者血压恢复至70/50 mmHg（1 mmHg=0.133 kPa），意识恢复；2.5 h后患者出现全身水肿伴皮疹，再次给与抗过敏治疗。3 d后皮疹消失，11 d后水肿消退。“,”A 62-year-old female patient with bladder cancer received intravesical instillation of pirarubicin hydrochloride for injection (pirarubicin) after operation (30 mg dissolved into 5% glucose injection 30 ml was injected into the bladder through a catheter, and the instillation fluid was retained for 40 minutes). No adverse reactions occurred in the first 12 times of instillation. Seven months after operation, when the 13th instillation was performed for about 30 min, the patient developed numbness of lips, hands, and feet, profuse sweating, generalized flush, loss of consciousness, incontinences of fecal and urine, undetectable blood pressure, and heart rate of 110 beats/min. Anaphylactic shock caused by pirarubicin was considered. The bladder instillation fluid was drained immediately and treatments of anti-allergy, cardiotonic, and raising blood pressure were given. The patient′s blood pressure returned to 70/50 mmHg and consciousness recovered after 1 hour. Two and a half hours later, the patient developed systemic edema and rashes. Anti-allergy treatments were re-given. The rashes disappeared 3 days later and edema subsided 11 days later.