Iodide mumps following fistulogram in a haemodialysis patient

Abstract

SUMMARYIodide mumps, or contrast-induced acute sialadenitis, is characterised by rapid, painless enlargement of the salivary glands, following the use of iodinated contrast dye. The underlying mechanism of this adverse reaction is not completely understood. It could be due to an idiosyncratic reaction or related to deposition of iodide in the ductal systems of the salivary glands causing blockage and inflammation. With increasing renal dysfunction, the elimination half-life of the iodinecontaining contrast dye gets prolonged. The course of iodine-induced sialadenitis is usually benign, and rapid resolution of symptoms is expected without definite treatment. The symptomatic management includes treatment with a parenteral non-steroidal antiinflammatory drug (NSAID), steroids and dialysis. However, the role of steroids has been found to be controversial in previously published case reports. Pancreatic mumps and transient thyroid dysfunction were also reported in patients following iodinated contrast administration; the aetiology of this is thought to be similar to iodide-induced sialadenitis. BACKGROUND

Characterization of Iodide-induced Sialadenitis: Meta-analysis of the Published Case Reports in the Medical Literature

“…Although recurrence of iodine mumps may occur, the reaction clearly is not a contrast allergy and premedication protocols are not warranted. Analgesia may be helpful as gland tenderness was a dominant symptom in multiple cases (27,46,47), but overall there was no statistically significant difference in days to symptom resolution for those who received therapeutic intervention versus those who did not in our results; this may also explain why prophylaxis was ineffective in patients who had recurrence after repeat contrast administration.…”

“…Characteristic ultrasound findings include diffuse gland edema and enlargement with prominent hypoechoic internal septa (Fig 3) (30). Nonspecific gland enlargement and edema were also documented with computed tomography (CT) and magnetic resonance (MR) (27). While imaging can exclude other causes of gland enlargement, further diagnostic imaging is not indicated given appropriate patient history and could potentially exacerbate symptoms if performed with additional iodinated contrast material.…”

“…The natural history of iodine mumps is benign and self-limited, which favors a conservative approach with observation, supportive therapy, and patient education (4,27). Based upon this collected cohort of case reports, clinicians faced with this entity often treat it as an immunologic response, administering steroids and/or antihistamines to combat the reaction.…”

“…Based upon this collected cohort of case reports, clinicians faced with this entity often treat it as an immunologic response, administering steroids and/or antihistamines to combat the reaction. The reported efficacy of these pharmacologic treatments is purely anecdotal and, in the absence of a controlled clinical study, likely targeted at the wrong physiologic process (10,27). Allergic skin testing with contrast material in three different cases was negative (9,26,61).…”