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Vegetating iodides after an intravenous pyelogram.

P Lauret, M Godin, P Bravard

    Dermatologica
    |January 1, 1985
    PubMed
    Summary
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    Iodine contrast media can cause severe skin reactions, including aseptic pustules and vegetating masses, in patients with chronic renal failure undergoing hemodialysis. Prompt hemodialysis and local care facilitated healing in a case of severe iodine-induced skin toxicity.

    Area of Science:

    • Dermatology
    • Nephrology
    • Radiology

    Background:

    • Chronic renal failure (CRF) patients undergoing hemodialysis are at risk for adverse reactions to iodinated contrast media (ICM).
    • Iodine overload can occur in patients with impaired renal function, leading to potential toxicity.

    Observation:

    • A 68-year-old woman with CRF on hemodialysis developed aseptic pustules evolving into vegetating facial masses three days after intravenous pyelogram with 30.4 g iodine.
    • Skin biopsy revealed dermo-epidermal necrosis, polymorphonuclear infiltrates, and necrotizing vasculitis.
    • Elevated serum iodine levels were detected.

    Findings:

    • The patient's severe skin reaction was attributed to iodine overload from the contrast agent.
    • Histopathological examination confirmed a necrotizing vasculitis pattern.

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  • Four similar cases in renal failure patients were identified in the literature.

    • Implications:

    • This case highlights the potential for severe cutaneous adverse reactions to ICM in CRF patients.
    • Vigilance and prompt management, including hemodialysis, are crucial for treating iodine-induced skin toxicity.
    • Further research into risk factors and preventive strategies for ICM reactions in renal impairment is warranted.