Case report: multisystem failure following intravenous iopamidol

Area of Science:

• Radiology
• Pharmacology
• Critical Care Medicine

Background:

• Intravenous contrast media are widely used in medical imaging.
• Non-ionic contrast agents are generally considered safer than ionic agents.
• Adverse reactions, though uncommon, can range from mild to life-threatening.

Observation:

• A 68-year-old male with diabetes and hypertension presented with dyspnea and cough.
• Computed tomography (CT) of the chest was performed using iopamidol, a non-ionic contrast medium.
• The patient rapidly developed severe systemic symptoms including hypotension, fever, and delirium.

Findings:

• The patient experienced disseminated intravascular coagulation, rhabdomyolysis, renal failure, respiratory arrest, and atrial fibrillation.
• Infection, neoplastic disease, and myocardial infarction were ruled out as causes.
• The clinical presentation met criteria for a probable adverse drug reaction to the contrast agent.

Implications:

• This case underscores the potential for severe, multi-system adverse events from intravenous contrast media.
• Vigilant monitoring of patients post-contrast administration is crucial, especially in those with comorbidities.
• Further research into predicting and mitigating severe contrast reactions is warranted.