A 33-year-old patient diagnosed with hyperlipidemic pancreatitis underwent double filtration plasmapheresis (DFPP) for lipid-lowering therapy, with nafamostat mesylate used as the anticoagulant. Two minutes after initiating DFPP, the patient suddenly developed hypotension, transient syncope, palpitations, shortness of breath, pallor, with blood pressure dropping to 65/45 mmHg, heart rate rising to 140 beats per minute, and oxygen saturation falling to 86%. Anaphylactic shock was suspected, and DFPP was immediately discontinued. Anti-allergic and anti-shock treatments were administered, the patient's symptoms improved rapidly. Subsequently, heparin was used as the anticoagulant for another DFPP session, and no further anaphylactic shock occurred. The Naranjo’s Assessment Scale was applied for causality assessment, yielding a score of 7, indicating that nafamostat mesylate was a probable cause of the anaphylactic shock. This case suggests that when using nafamostat mesylate in clinical practice, close monitoring of vital signs is essential. For patients with a history of allergies, skin testing may be considered when necessary to prevent anaphylactic shock.

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