563: IODODERMA WITH RESPIRATORY COMPROMISE TREATED WITH HEMODIALYSIS

Abstract

Introduction: Iododerma is a rare, delayed type IV hypersensitivity reaction due to iodine deposition within the skin. With only a few published case reports, iododerma as a syndrome has been associated with exposure to iodine-containing materials such as contrast media, amiodarone, or povidone-iodine solution, with most cases involving lesions along the face and upper extremities (1). Diagnosis of iododerma is difficult, as lesions can raise concern for infection or vasculitis. We highlight a case of iododerma leading to airway compromise which was successfully treated with hemodialysis. Description: A 51 yo F with a PMH of diabetes mellitus, CKD stage IV, and diastolic heart failure presented with symptomatic anemia and underwent workup that included a CT abdomen and pelvis with oral contrast. She returned nine days later with evolving necrotic skin lesions within the perioral and periorbital areas. She developed facial and supraglottic mucosal edema with extensively sloughing bullous lesions and required intubation. A skin biopsy demonstrated neutrophilic infiltrates with a cryptococcoid appearance consistent with neutrophilic dermatosis. Urine and serum iodine were significantly elevated (15143.4 and 10822.5 respectively), consistent with a diagnosis of iododerma. She was started on high dose corticosteroids and initiated on intermittent hemodialysis to assist with clearance of iodine. Following three sessions of hemodialysis, patient had a significant clinical improvement and reduction in iodine levels with successful extubation on hospital day 11. Discussion: Iododerma is largely a diagnosis of exclusion but should be considered in patients with suggestive skin lesions and recent exposure to iodine-containing materials, particularly patients with underlying renal dysfunction. Diagnosis is typically made with a skin biopsy demonstrating neutrophilic infiltrates with structures that mimic Cryptococcus, in conjunction with elevated serum and urine iodine levels (2). While treatment with steroids is typical, we highlight a case where hemodialysis led to rapid clinical improvement in a very severe case of iododerma, suggesting utility in the ICU setting. 1. Tasker et al., 2019. Clin Exp Dermatol, 44: 844-860. 2. Runge et al, 2020. JAAD Case Reports, 6 (4): 319-322.