Iodinated contrast media-induced fixed drug eruption

Jisu Shim; Soojie Chung; Gun-Woo Kim; Kyoung-Hee Sohn; Ju-Young Kim; Hye-Ryun Kang

doi:10.4168/aard.2015.3.5.375

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This article has been corrected. See "ERRATUM: Acknowledgments Correction. Iodinated contrast media-induced fixed drug eruption" in Volume 3 on page 461.

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Shim, Chung, Kim, Sohn, Kim, and Kang: Iodinated contrast media-induced fixed drug eruption

Case Report

Allergy, Asthma & Respiratory Disease 2015; 3(5): 375-379.

Published online: 30 September 2015

DOI: https://doi.org/10.4168/aard.2015.3.5.375

Iodinated contrast media-induced fixed drug eruption

Jisu Shim^1,², Soojie Chung^1,², Gun-Woo Kim^1,², Kyoung-Hee Sohn^1,², Ju-Young Kim^1,^2,³, Hye-Ryun Kang^1,^2,³

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

³Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Hye-Ryun Kang. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-0820, Fax: +82-2-742-3291, helenmed@snu.ac.kr

Received 23 June 2015 Revised 25 July 2015 Accepted 5 August 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Iodinated contrast media (ICM) can cause not only immediate onset hypersensitivity but also delayed onset hypersensitivity. While the most common form of delayed onset hypersensitivity reaction to ICM is exanthematous eruption, fixed drug eruption (FDE) can occur rarely related to ICM. A 70-year-old male with liver cirrhosis and hepatocellular carcinoma repeatedly experienced erythematous patches on his right forearm and hand 6 hours after exposure to iopromide for computed tomography scan. ICM induced FDE was diagnosed clinically. Intradermal test with 6 kinds of ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, and iodixanol) was performed and showed the weakest positive reaction to iohexol compared to the others in 48 hours. After changing iopromide to iohexol based on these results, FDE did not recur. We report here a case of iopromide induced FDE which was successfully prevented by changing ICM to iohexol based on intradermal test results.

Keywords: Contrast media, Drug eruptions, Delayed hypersensitivity, Intradermal tests

Figures and Tables

Fig. 1

Erythematous patch on the right forearm developed one day after computed tomography scan with iodinated contrast media.

Table 1

The result of intradermal skin test with iodinated contrast media

	Purplish discoloration (mm)
Saline	No increase
Iobitridol	3.0 × 3.0
Iohexol	2.0 × 1.5
Iomeprol	3.0 × 3.0
Iopamidol	3.0 × 3.0
Iopromide	4.0 × 3.0
Iodixanol	3.0 × 3.0

Iobitridol tested with Xenetix350, iohexol with Omnipaque350, iomeprol with Iomeron400, iopamidol with Pamiray370, iopromide with Ultravist370, iodixanol with Visipaque320.

Table 2

Summary of ICM induced fixed drug eruption case reports

Source	Age/sex	Causative ICM	The clinical indication of ICM	Clinical features	Patch testing	Intradermal testing	Clinical courses
Wright and Cohen12)	41 yr/F	Iopamidol	Underlying lupus nephritis, to evaluate arteriovenous shunt patency	Multiple; erythematous patches (3 cm×5 cm); the lower limbs; a few hours after administration	Iopamidol (+)	Not tested	Not stated
					Iohexol (-)
					Ioxagllic acid (-)
					Iotrolan (-)
					Iodoxamic acid (-)
					Iodamid (-)
					Ioversol (-)
Cha et al.3)	69 yr/M	Iopromide	Underlying non-ST-elevation myocardial infarction, for percutaneous transluminal angioplasty	Multiple; erythematous patches (3-5 cm); both palms and trunk; several days after administration	Iopromide (-)	Not tested	Not stated
Benson et al.7)	61 yr/M	Iopromide	To exclude the neoplasm	Single; erythematous patch (15 cm×8 cm); the right inguinal region; 4 hr after administration	Iopromide (-)	Not tested	After changing to iopamidol based on skin test, FDE did not recur.
					Iomeprol (+)
					Iohexol (+)
					Iopamidol (-)
					Iotrolan (-)
					Iodixanol (-)
					Ioxaglate (-)
Le Beller et al.10)	67 yr/F	Iomeprol	To evaluate response for chemotherapy regularly (breast cancer)	Multiple; erythematous papules (pea-sized); the trunk and extremities; 4 days after administration	Iomeprol (+)	Iomeprol (+)	Not stated
					Ioversol (-)
					Iohexol (-)
					Iotrolan (-)
					Iopamidol (-)
Bohm et al.8)	60 yr/M	Ioversol	To evaluate a aortic aneurysm regularly	Multiple; erythematous and blistering eruptions (1 cm); the back and both hands; 24 hr after administration	Ioversol (+)	Not tested	Not stated
					Iopamidol (+)
					Iohexol (+)
Hosoya et al.6)	51 yr/F	Iothalamate	To evaluate a right-sided pulmonary mass	Single; erythematous plaque (8 cm); the right thigh; 12 hr after administration	Not tested	Not tested	Not stated
Watanabe et al.11)	57 yr/F	Iohexol	Follow-up surveillance appointments for renal cell carcinoma every 6 months	Single; erythematous patch (9 cm×13 cm); the left breast; 15 hr after administration	Not tested	Not tested	Not stated
Frias et al.9)	27 yr/F	Iodinaxol	Underlying end-stage renal failure due to AA amyloidosis, for arteriovenous fistula patency intervention	Multiple; erythematous lesions (size not clearly stated.); a few hours after administration	Not tested	Not tested	After changing to iobitridol empirically, FDE did not recur
Jin et al.14)	48 yr/M	Iodinaxol	Underlying end-stage renal failures, for percutaneous transluminal angioplasty to arteriovenous fistula	Multiple; oval shaped, brownish to violaceous patches (size not clearly stated.); several hours after administration	Iopamido (-)	Not tested	Skin prick tests were performed, the results were all negative.
					Iomeprol (-)		Provocation test was performed, the result was positive.
					Ioversol (-)
					Iopromide (-)
					Iohexol (-)
					Iodixanol (-)

ICM, iodinated contrast media; FDE, fixed drug eruption; AA, amyloid A.

Notes

The study was sponsored by South Korea's Ministry of Food and Drug Safety.

References

1. Shin MJ, Cho YJ. Management of adverse reaction to iodinated radiocontrast media. J Korean Med Assoc. 2012; 55:779–790.

2. Jung JW, Cho SH, Kim KH, Min KU, Kang HR. Clinical features of fixed drug eruption at a tertiary hospital in Korea. Allergy Asthma Immunol Res. 2014; 6:415–420.

3. Cha SH, Kim HS, Lee JY, Kim HO, Park YM. Fixed drug eruption due to iopromide (Ultravist). Ann Dermatol. 2011; 23:Suppl 1. S33–S35.

4. Kim MH, Lee SY, Lee SE, Kim MY, Jo EJ, Park CM, et al. Clinical features of delayed contrast media hypersensitivity. Allergy Asthma Respir Dis. 2014; 2:352–357.

5. Shiohara T, Mizukawa Y. Fixed drug eruption: the dark side of activation of intraepidermal CD8+ T cells uniquely specialized to mediate protective immunity. Chem Immunol Allergy. 2012; 97:106–121.

6. Hosoya T, Yamaguchi K, Akutsu T, Mitsuhashi Y, Kondo S, Sugai Y, et al. Delayed adverse reactions to iodinated contrast media and their risk factors. Radiat Med. 2000; 18:39–45.

7. Benson PM, Giblin WJ, Douglas DM. Transient, nonpigmenting fixed drug eruption caused by radiopaque contrast media. J Am Acad Dermatol. 1990; 23(2 Pt 2):379–381.

8. 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.

9. Frias M, Fernandez E, Audicana MT, Longo N, Munoz D, Reyes SM. Fixed drug eruption caused by iodinated contrast media. Contact Dermatitis. 2011; 65:43–44.

10. 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.

11. 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.

12. Wright NA, Cohen PR. Fixed drug eruption associated with intravenous contrast media: report in a woman receiving iohexol. J Drugs Dermatol. 2011; 10:802–804.

13. Yamauchi R, Morita A, Tsuji T. Fixed drug eruption caused by iopamidol, a contrast medium. J Dermatol. 1997; 24:243–245.

14. Jin SY, Kim DH, Choi YS, Kwon JH, Lee AY, Lee SH. Iodixanol-induced fixed drug eruption diagnosed by systemic provocation test. Korean J Dermatol. 2012; 50:1073–1076.

15. Brockow K. Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism? Immunol Allergy Clin North Am. 2009; 29:453–468.

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ORCID iDs: Hye-Ryun Kang
https://orcid.org/http://orcid.org/0000-0002-2317-4201
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