Ma Xiuxiu, He Chaozhu, Zeng Xiaohong, He Xiaohua, Bi Yanfang
School of Nursing, Nanchang University, First Clinical Medical College, Jiangxi Medical College, Nanchang University, Jiangxi, China.
School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Medicine (Baltimore). 2025 Jan 31;104(5):e41301. doi: 10.1097/MD.0000000000041301.
Acute generalized exanthematous pustulosis (AGEP) is a rare delayed allergic reaction, which is mostly caused by drugs, but there are few reports of iodixanol in particular. At present, 4 cases induced by iodixanol have been reported in the literature, but none have been reported in China.
In this report, we report a case of AGEP induced by intravenous bolus infusion of iodixanol during multislice spiral CT enhanced scanning of the whole abdomen in a patient with rectal malignancy. A 35-year-old female patient presented with a larger rash/erythema on the head and neck and felt itchy.
A large erythema/rash and white, sterile pustules based on erythema spread from head, neck to the whole body in a short period of time. Blood cell results showed high levels of white blood cell, neutrophils, C-reactive protein and interleukin-10, and decreased levels of some immune indicators. Pathological biopsy results showed that there was immune cell infiltration around the superficial dermis.
Immediate avoidance of potential allergens and treatment with steroids, antihistamines and other medications, followed by adjustment with cyclosporine and human immunoglobulin.
At 1 year's follow-up, the patient did not develop any symptoms of discomfort and increased awareness of allergen prevention.
The reported case is an extremely rare and severe AGEP, typically characterized by pruritus, edema, large erythema/rash, dense white needle-like sterile pustules based on erythema/rash, and desquamation. After discontinuation of exposure to iodixanol, the patient received symptomatic supportive treatment, mainly drug response. She eventually recovered without recurrence. In the future, with the in-depth exploration of more studies, the use of Iodine Contrast Media will be more standardized and scientific.
急性泛发性脓疱性皮病（AGEP）是一种罕见的迟发性过敏反应，主要由药物引起，但关于碘克沙醇的报道尤其少见。目前，文献中已报道4例由碘克沙醇诱发的病例，但中国尚无相关报道。
在本报告中，我们报道了1例直肠恶性肿瘤患者在全腹多层螺旋CT增强扫描期间静脉推注碘克沙醇诱发AGEP的病例。一名35岁女性患者头颈部出现大片皮疹/红斑，伴有瘙痒感。
短时间内，大片红斑/皮疹及基于红斑的白色无菌脓疱从头部、颈部蔓延至全身。血细胞检查结果显示白细胞、中性粒细胞、C反应蛋白和白细胞介素-10水平升高，部分免疫指标水平降低。病理活检结果显示浅表真皮周围有免疫细胞浸润。
立即避免接触潜在过敏原，并使用类固醇、抗组胺药等药物进行治疗，随后调整使用环孢素和人免疫球蛋白。
随访1年时，患者未出现任何不适症状，且预防过敏原的意识增强。
报道的该病例是极为罕见且严重的AGEP，其典型特征为瘙痒、水肿、大片红斑/皮疹、基于红斑/皮疹的密集白色针状无菌脓疱及脱屑。停用碘克沙醇后，患者接受了对症支持治疗，主要是药物反应。她最终康复且未复发。未来，随着更多研究的深入探索，碘造影剂的使用将更加规范和科学。
