The patient, a 55-year-old man with no known allergies diagnosed with gastric adenocarcinoma, was admitted in November 2001 to the Digestive Department of the Hospital Son Dureta where he underwent a subtotal gastrectomy with reconstruction of the transit by means of a Billroth II gastrojejunostomy. Five days after the surgery, the patient's clinical situation required the prescription of artificial nutrition, and the administration of TPN via the central line was started. The preparation administered was Kabimix® (see detailed composition in table I), a 2,553 kilocalorie diet supplemented in the Pharmacy Service with a multivitamin preparation (PMV) (Cernevit®) and trace elements (Addamel®) on alternate days. 48 hours after the introduction of parenteral nutrition, it was decided to change the type of diet in order to administer a formula more suited to the patient's nutritional requirements, so the patient received the Kabiven® formula supplemented with the same PMV and trace elements every other day, starting with the vitamins. Within 24 hours of starting the infusion of this diet, the patient presents with a significant disseminated pruritic rash requiring the administration of oral dexchlorpheniramine. Mechanical complications caused the loss of the central line, leading to the decision to withdraw the TPN and initiate oral tolerance. On the eighth day after surgery, the patient reported severe abdominal pain, which led to an exploratory laparotomy and the detection of an abscess with a biliary collection. TPN was restarted by administering the Kabiven® diet supplemented with the aforementioned PMV. A few hours after starting the infusion, a new episode of disseminated pruritic skin rash occurred, which led to the definitive suspension of TPN.

In March 2003, the patient went to the emergency department of the aforementioned hospital for fever and abdominal pain, was diagnosed with cholangitis and was admitted to the Digestive Department. In addition to antibiotic and analgesic treatment, an absolute diet was prescribed and, due to the history of hypersensitivity, TPN was avoided, and an amino acid and glucose solution (Aminoven®, table III) was administered, without erythema being observed or the patient reporting pruritus. After 48 hours, lipid emulsion (Intralipid® 10%, table III) was added centrally without any complications. On this occasion, it was decided not to administer PMV or trace elements to the patient. After several days of hospitalisation, progression of the gastric neoformative process was observed and the patient died in April 2003.