Bilateral Ischemic Optic Neuropathy following Benzathine Penicillin: Hoigne Syndrome

Hoigne Syndrome is a pseudoanaphylactic reaction that occurs shortly after intramuscular administration of penicillin G procaine or benzathine. These are embolic toxic reactions possibly due to vascular occlusions by large crystals of the penicillin salts (1), although the mechanism responsible for the development of Hoigne Syndrome, and its incidence, are unknown (2). Clinical manifestations include psychosis, seizures (3), "doom anxiety" (2), visual and auditory hallucinations, dysarthria, dyspnea, tachycardia (1). Other drugs, such as lidocaine (2), clarithromycin (4), and ceftriaxone (5) have been associated with Hoigne syndrome. Management guidelines include prompt recognition, patient reassurance and benzodiazepines (2).