Allergy Asthma Respir Dis.  2018 Sep;6(5):270-273. 10.4168/aard.2018.6.5.270.

Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

Affiliations
  • 1Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea. mdqueen@hallym.or.kr
  • 2Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Abstract

Acute generalized exanthematous pustulosis (AGEP) is rarely caused by radiocontrast media (RCM). The role of skin tests for the diagnosis and evaluation of cross-reactivity in a delayed type of RCM-induced hypersensitivity have yet to be determined. Here, we report a case of iodixanol-induced AGEP where we safely administered alternative RCM using patch tests. A 44-year-old woman had coronary artery angiography (CAG) for the evaluation of ischemic heart disease. She was on regular hemodialysis because of end-stage renal disease. She was given iodixanol (Visipaque) during CAG. Approximately 1 day after CAG, she developed AGEP. The patient was rehospitalized for CAG again after 1 year. We performed skin tests to choose safe alternative RCM. Intradermal tests with iodixanol, iohexol (Bonorex) and Iopamidol (Pamiray) showed negative responses. Patch tests showed a positive response to iodixanol, equivocal to iohexol, and negative to Iopamidol. We finally chose Iopamidol and performed CAG successfully without any adverse reaction. Patch tests may be a useful tool for the diagnosis and choice of safe alternatives in RCM-induced delayed-type hypersensitivity reactions such as AGEP.

Keyword

Radiocontrast media; Acute generalized exanthematous pustulosis; Skin test

MeSH Terms

Acute Generalized Exanthematous Pustulosis*
Adult
Angiography
Contrast Media*
Coronary Vessels
Diagnosis
Female
Humans
Hypersensitivity
Intradermal Tests
Iohexol
Iopamidol
Kidney Failure, Chronic
Myocardial Ischemia
Patch Tests*
Renal Dialysis
Skin Tests
Contrast Media
Iohexol
Iopamidol

Figure

  • Fig. 1 Generalized exanthematous rash with numerous small pustules was shown 1 day after coronary angiography using iodixanol (Visipaque, GE Healthcare, Chicago, IL, USA).

  • Fig. 2 Skin punch biopsy shows microabscess in horny layer of epidermis and infiltration of eosinophils in the upper dermis (H&E, ×100).

  • Fig. 3 Patch tests show positive response to iodixanol, equivocal response to iohexol, and negative response to iopamidol 96 hours after patch application.


Cited by  1 articles

Is skin test helpful in selecting alternative contrastmedia in contrastmedia hypersensitivity patients?
Tae-Bum Kim
Allergy Asthma Respir Dis. 2018;6(5):235-236.    doi: 10.4168/aard.2018.6.5.235.


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