Acute iododerma secondary to iodinated contrast media

Young, Alexis L.; Grossman, Marc E.

doi:10.1111/bjd.12852

Cited by 20 publications

(25 citation statements)

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“…Iododerma, a type of halogenoderma, is a rare neutrophilic dermatosis occurring after exposure to iodine including ICM, irrigation of wounds with povidine iodine, ingestion of iodide supplements and the use of amiodorone. In total, 17 cases of iododerma caused by ICM have been identified (Table ) . These comprised 10 women and 7 men, with an average age of 59 years (range 49–81 years).…”

Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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Contrast media (CM) are an indispensable part of modern medical imaging. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 covers the classification of CM, immediate hypersensitivity reactions to CM and the newly described condition, gadolinium deposition disease. Given that there has only been two case reports to our knowledge of a delayed adverse reaction to gadolinium-based CM, this second part will focus on cutaneous delayed reactions caused by iodinated CM (ICM). Delayed hypersensitivity reactions to ICM commonly present as maculopapular exanthems, but more rarely, they can manifest as fixed drug eruptions, acute generalized exanthematous pustulosis, drug-related eosinophilia and systemic symptoms, Stevens-Johnson syndrome/ toxic epidermal necrolysis, symmetrical drug-related intertriginous and flexural exanthema, graft-versus-host disease, vasculitis and iododerma. Delayed reactions to ICM may be underdiagnosed, as cutaneous symptoms may be attributed to oral medications, particularly if patients are on multiple drugs.

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Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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“…Urinary iodine levels (normal range 42–350 μg/L) or blood iodine levels (normal range 40–92 μg/L) are usually elevated in this condition; however, the tests are performed only by a few laboratories. Marked eosinophilia is common in this syndrome …”

Section: Discussionmentioning

confidence: 93%

“…Iododerma is most commonly localized to areas with a high density of sebaceous glands, with satellite lesions on the extremities, particularly on the hands. Although in most cases the condition is self‐limiting, it may cause disfigurement and can even be fatal …”

Section: Discussionmentioning

confidence: 99%

Vegetating lesions from contrast material in a patient with chronic renal failure

et al. 2019

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A 51-year-old hypertensive woman with a history of chronic renal failure, who was receiving haemodialysis through a permanent catheter in the right internal jugular vein, presented with progressive facial oedema and sudden hoarseness. Cavography with iodine contrast was performed, which showed 95% obstruction of blood flow through the superior vena cava, and the patient was diagnosed with superior vena cava syndrome. Several hours later, painful pustules developed on the patient's face. Cavography was repeated to remove the catheter from the jugular vein, and a new catheter was placed in the right femoral vein. One day later, the patient developed pruritic, tense haemorrhagic bullae on her arms and legs. The facial pustules coalesced into vesicles and vegetating lesions appeared, with drainage of purulent secretion on the patient's face (Fig. 1). The patient was afebrile with stable vital signs. Laboratory studies indicated eosinophilia (35% eosinophils; normal range 1-4%), while white cell count was normal (9.85 9 10 9 /L; normal range 4-11 9 10 9 /L). Histopathological findingsThe results of microbiological studies were negative. Histopathological examination of an arm lesion revealed epidermal necrosis with ulceration and a mixed infiltrate with predominance of neutrophils in the dermis, dermal and epidermal necrosis with haemorrhagic areas and a superficial neutrophilic infiltrate (Fig. 2). Figure 1 (a) Tense haemorrhagic bullae on the patient's arms; (b) vegetating lesions draining purulent secretion on the patient's face.ª

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“…The most common presentation of iododerma is an acneiform eruption; however, edematous, bullous, or hemorrhagic lesions can develop and evolve to vegetative nodules in advanced disease. 1 , 2 , 9 Skin lesions in iododerma localize to the regions of the skin with high sebaceous gland density, and satellite lesions are seen on the extremities, especially the hands. 3 , 4 , 9 A similar presentation can be seen with the intake of other halogenated compounds containing bromine and fluorine.…”

Section: Discussionmentioning

confidence: 99%

“… 8 One study of patients with end-stage renal disease who received iodinated contrast documented that the plasma half-life of the contrast was increased to 23 hours compared with 2 hours in those with normal kidney function. 9 The pathophysiology of iododerma is currently unknown, but it is speculated to be the induction of a delayed hypersensitivity reaction via iodine acting as a hapten. 1 …”

Section: Introductionmentioning

confidence: 99%