| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
S. Alergología, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
Toxic epidermal necrolysis has been infrequently related to contrast media [1]. We report a severe adverse reaction, suggestive of toxic epidermal necrolysis, induced by iohexol, an IV contrast medium. After a motorcycle crash, a 33-year-old man underwent contrast-enhanced body CT that revealed hepatic injuries. A laparotomy was performed.
Five days later, the patient presented with fever (39°C), and a second body CT with contrast medium (iohexol) was performed to rule out a possible intraabdominal abscess. He received treatment with piperacillin-tazobactam (2/0.25 mg every 8 hr) and fluconazole (200 mg every 12 hr). Treatment was subsequently changed to ciprofloxacin (500 mg every 12 hr) and vancomycin (500 mg every 6 hr). Three blood and urine cultures were negative for bacteria.
Nine days after a third contrast-enhanced body CT, an erythematous disseminated skin rash appeared. Because of a suspicion of drug allergy, all antibiotics were withdrawn, and corticoids and antihistamines were prescribed.
Because of persistent fever, a fourth body CT was performed using iohexol. Two hours later, the patient developed malaise, pruritic erythema, hypotension, and cutaneous bullae affecting 50% of his body surface that peeled off in sheets, with oral mucosal involvement (Fig. 6A). Diagnosis of toxic epidermal necrolysis was established, and the patient was admitted to the intensive care unit. He was treated with epinephrine, corticosteroids, and antihistamines. His skin healed without scarring or alteration of pigmentation.
|
Epicutaneous patch tests in water with piperacillin-tazobactam (4/0.5 mg/mL), fluconazole (2 mg/mL), ciprofloxacin (2 mg/mL), and vancomycin (50 mg/mL and 5 mg/mL) were negative at 48 and 96 hr. Skin prick, intradermal tests, and IV and oral single-blinded challenges with all antibiotics were negative.
The patch test with iohexol (300 mg/mL in water) was positive: 48 hr after the patch test, erythema and multiple small, flaking blisters appeared in the patch area (Fig. 6B). Identical patch tests in 10 healthy control subjects were negative.
|
Our patient suffered a delayed reaction to iohexol suggestive of toxic epidermal necrolysis. Another type of delayed reaction, fixed eruption associated with fever, has been reported [2]. In our patient, epidermal necrolysis involving more than 30% of his body surface and mucosa supported the diagnosis of toxic epidermal necrolysis.
The lesions in the patch area suggested a delayed hypersensitivity mechanism, which has been described elsewhere [3]. Frequently, the bullous reaction to iohexol is preceded by an erythematous rash [1]. In our patient the first rash appeared 9 days after contrast administration while the patient was undergoing antibiotic treatment, which caused a delay in diagnostic suspicion. In patients with multiple trauma requiring radiologic procedures who present with symptoms suggestive of adverse drug reactions, contrast media should not be overlooked as a possible cause.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
