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

Sun-Hyung Kim; Seung-Youn Lee; Young-Hee Choi; Cheol-Hong Kim; In-Kyu Hyun; Jeong-Hee Choi

doi:10.4168/aard.2018.6.5.270

Journal List > Allergy Asthma Respir Dis > v.6(5) > 1101789

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Kim, Lee, Choi, Kim, Hyun, and Choi: Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

Case Report

Allergy, Asthma & Respiratory Disease 2018; 6(5): 270-273.

Published online: 28 September 2018

DOI: https://doi.org/10.4168/aard.2018.6.5.270

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

Sun-Hyung Kim¹, Seung-Youn Lee¹, Young-Hee Choi², Cheol-Hong Kim¹, In-Kyu Hyun¹, Jeong-Hee Choi¹

¹Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

²Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Correspondence to: Jeong-Hee Choi. Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong 18450, Korea. Tel: +82-31-8086-2928, Fax: +82-31-8086-2482, mdqueen@hallym.or.kr

Received 7 September 2017 Revised 2 October 2017 Accepted 15 December 2017

The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(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/4.0/).

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.

Keywords: Radiocontrast media, Acute generalized exanthematous pustulosis, Skin test

Figures and Tables

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.

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ORCID iDs: Jeong-Hee Choi
https://orcid.org/0000-0002-0599-875X
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