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碘造影剂复合物皮疹对局部类固醇治疗有反应:一例报告

Iodine Contrast Complex Rash Responding to Topical Steroids: A Case Report.

作者信息

El Hussein Mahmoud, Hamieh Cima, Zaghrini Elie

机构信息

Department of Emergency Medicine, Lebanese American University (LAU) Medical Center, Beirut, Lebanon.

Department of Family Medicine, Lebanese American University (LAU) Medical Center, Beirut, Lebanon.

出版信息

Am J Case Rep. 2021 Apr 7;22:e928930. doi: 10.12659/AJCR.928930.

Abstract

BACKGROUND Iodine contrast allergy can cause acute and delayed allergic reactions. Just like any other sensitivity reaction, the severity can vary from mild to moderate skin manifestations such as erythematous rash to an even more severe presentation or life-threatening event, such as angioedema and anaphylaxis. CASE REPORT This case report discusses a patient who presented to our institution with a diffuse complex rash 2 days after undergoing CT scan imaging with intravenous iodine contrast injection. The rash started by being maculopapular in nature. Later on, the patient developed a purpuric and petechial pattern, and eventually, an acute exanthematous pustulosis rash was noticed. Several attempts to treat the patient with intravenous corticosteroids failed. Three days after admission (5 days after the rash started), topical steroids were used in place of parenteral steroids. The rash showed remarkable improvement in a very short time. The patient was diagnosed with delayed hypersensitivity IV iodine reaction, resistant to parenteral corticosteroids. The workup of such an extensive rash and odd presentation include several laboratory tests and skin testing to be able to rule out more serious differential diagnoses. CONCLUSIONS This case is unique as it enables us to show the importance of substituting topical management, more specifically, topical steroids that might even replace parenteral steroids, to our management in order to treat allergic reactions, especially in the presence of a rash.

摘要

背景 碘造影剂过敏可引起急性和迟发性过敏反应。与任何其他过敏反应一样,其严重程度可从轻微至中度的皮肤表现,如红斑疹,到更严重的表现或危及生命的事件,如血管性水肿和过敏反应。病例报告 本病例报告讨论了一名患者,该患者在接受静脉注射碘造影剂的CT扫描成像后2天,出现弥漫性复合性皮疹前来我院就诊。皮疹起初为斑丘疹。后来,患者出现紫癜和瘀点样皮疹,最终出现急性发疹性脓疱病皮疹。多次尝试用静脉注射皮质类固醇治疗该患者均失败。入院3天后(皮疹出现5天后),改用外用类固醇代替胃肠外类固醇。皮疹在很短时间内有显著改善。该患者被诊断为对静脉注射碘的迟发性超敏反应,对胃肠外皮质类固醇耐药。对如此广泛的皮疹和奇特表现进行检查包括多项实验室检查和皮肤试验,以便能够排除更严重的鉴别诊断。结论 本病例具有独特性,因为它使我们能够证明在治疗过敏反应时,尤其是出现皮疹时,改用局部治疗,更具体地说是外用类固醇,甚至可能替代胃肠外类固醇进行治疗的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/883a/8042418/b3c3fb85d0f0/amjcaserep-22-e928930-g001.jpg

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