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Acute Generalized Exanthematous Pustulosis as a Delayed Dermatotoxic Reaction to IV-Administered Nonionic Contrast Media

Aaron Peterson1, Richard W. Katzberg1, Maxwell A. Fung2,3, Sandra L. Wootton-Gorges1 and William Dager4

1 Department of Radiology, University of California Davis Medical Center, 4860 Y St., Ste. 3100, Sacramento, CA 95817.
2 Department of Dermatology, University of California Davis Medical Center, Sacramento, CA.
3 Department of Pathology, University of California Davis Medical Center, Sacramento, CA.
4 Department of Pharmacology, University of California Davis Medical Center, Sacramento, CA.


Figure 1
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  		Fig. 1 —44-year-old woman (case 1) with desquamating erythematous pustular eruption involving gluteal region and trunk.

 

Figure 2
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  		Fig. 2A —Trephine biopsy from skin of abdomen from same patient shown in Figure l. Epidermal and superficial dermal inflammatory infiltrates (H and E, x100). Note pustule (arrow).

 

Figure 3
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  		Fig. 2B —Trephine biopsy from skin of abdomen from same patient shown in Figure l. Higher magnification (x400) image of subcorneal pustule identified in A.

 

Figure 4
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  		Fig. 2C —Trephine biopsy from skin of abdomen from same patient shown in Figure l. Higher magnification (x600) shows scattered single apoptotic keratinocyte (arrow) and dermal eosinophil (curved arrow) features consistent with drug reaction, including acute generalized exanthematous pustulosis.

 

Figure 5
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  		Fig. 3 —30-year-old woman (case 2) with right lower lumbar region of back showing 1- to 2-mm erythematous papules, some having pustular appearance. No biopsy was obtained on this patient.

 

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