Korean journal of dermatology (대한피부과학회지)

Korean Dermatological Association (대한피부과학회)
권호 표지

Iodixanol-Induced Fixed Drug Eruption Diagnosed by Systemic Provocation Test

전신 유발검사로 진단한 Iodixanol에 의해 발생한 고정약진

  • Jin, Sang Yun (Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University) ;
  • Kim, Do Hun (Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University) ;
  • Choi, Yun Seok (Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University) ;
  • Kwon, Jae Hyun (Department of Radiology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University) ;
  • Lee, Ai Young (Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University) ;
  • Lee, Seung Ho (Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University)
  • 진상윤 (동국대학교 의과대학 일산병원 피부과학교실) ;
  • 김도훈 (동국대학교 의과대학 일산병원 피부과학교실) ;
  • 최윤석 (동국대학교 의과대학 일산병원 피부과학교실) ;
  • 권재현 (동국대학교 의과대학 일산병원 영상의학교실) ;
  • 이애영 (동국대학교 의과대학 일산병원 피부과학교실) ;
  • 이승호 (동국대학교 의과대학 일산병원 피부과학교실)
  • Published : 2012.12.31
⟨ Previous Next ⟩

Abstract

Most cases of delayed skin reactions attributed to non-ionic iodinated contrast media, reported to date, have been maculopapular rash, which frequently occurs on the trunk and proximal region of the extremities. Only few cases of fixed drug eruption caused by non-ionic iodinated contrast media have been reported. A 48-year-old man developed multiple sharply marginated, hyperpigmented, oval patches on the trunk and extremities after receiving iodixanol (Visipaque$^{(R)}$, GE healthcare, USA). The patch test was carried out with a panel of the available iodinated non-ionic contrast media, but did not induce a positive reaction to any of the tested contrast media. The provocation test was carried out with iodixanol as 1/10 of the amount administered during the procedure that caused the reaction. On the following morning, the lesions increased in size and number. We report a case of iodixanol-induced fixed drug eruption, diagnosed by a systemic provocation test.

Keywords

References

  1. Gueant-Rodriguez RM, Romano A, Barbaud A, Brockow K, Gueant JL. Hypersensitivity reactions to iodinated contrast media. Curr Pharm Des 2006;12:3359-3372 https://doi.org/10.2174/138161206778193999
  2. Delgado-Jimenez Y, Perez-Gala S, Aragues M, Sanchez- Perez J, Garcia-Diez A. Late skin reaction to iodixanol (Visipaque): clinical manifestations, patch test study, and histopathological evaluation. Contact Dermatitis 2006;55:348-353 https://doi.org/10.1111/j.1600-0536.2006.00957.x
  3. Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol 2000;1:277-285 https://doi.org/10.2165/00128071-200001050-00003
  4. Watanabe H, Sueki H, Nakada T, Akiyama M, Iijima M. Multiple fixed drug eruption caused by iomeprol (Iomeron), a nonionic contrast medium. Dermatology 1999;198:291-294 https://doi.org/10.1159/000018133
  5. Haussler MD. Safety and patient comfort with iodixanol: a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations. Acta Radiol 2010;51:924-933 https://doi.org/10.3109/02841851.2010.504739
  6. Le Beller C, Fraitag S, Jacquot C, Lillo-Le Louet A, Auffret N. Fixed drug eruption caused by iodixanol. Ann Dermatol Venereol 2008;135:684-685 https://doi.org/10.1016/j.annder.2008.05.006
  7. Bohm I, Medina J, Prieto P, Block W, Schild HH. Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol 2007;17:485-489 https://doi.org/10.1007/s00330-006-0371-6
  8. Calonje E, Brenn T, Lazar A, McKee PH. Mckee's pathology of the skin. 4th ed. Philadelphia: Elsevier, 2012:599- 600
  9. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw-Hill, 2012:454-455
  10. Andrade P, Brinca A, Goncalo M. Patch testing in fixed drug eruptions - a 20-year review. Contact Dermatitis 2011;65:195-201 https://doi.org/10.1111/j.1600-0536.2011.01946.x
  11. Vernassiere C, Trechot P, Commun N, Schmutz JL, Barbaud A. Low negative predictive value of skin tests in investigating delayed reactions to radio-contrast media. Contact Dermatitis 2004;50:359-366 https://doi.org/10.1111/j.0105-1873.2004.00367.x
  12. Torres MJ, Mayorga C, Cornejo-Garcia JA, Lopez S, Chaves P, Rondon C, et al. Monitoring non-immediate allergic reactions to iodine contrast media. Clin Exp Immunol 2008;152:233-238 https://doi.org/10.1111/j.1365-2249.2008.03627.x
  13. Hasdenteufel F, Waton J, Cordebar V, Studer M, Collignon O, Luyasu S, et al. Delayed hypersensitivity reactions caused by iodixanol: an assessment of cross-reactivity in 22 patients. J Allergy Clin Immunol 2011;128:1356-1357 https://doi.org/10.1016/j.jaci.2011.05.034