Delayed exfoliative dermatitis induced by iodixanol

Abstract

A 74-year-old female patient with coronary artery disease underwent primary percutaneous coronary intervention and received iodixanol 220 ml during the operation.Before the intervention, the patient's white blood cell (WBC) count was 8.6×109/L, neutrophil (N) count was 4.2×109/L, eosinophil (E) count was 0.36×109/L, and serum creatinine level was 122 μmol/L. On day 4 postoperation, the patient developed erythema of back and right upper limb, swelling of hands (especially the right hand). She was given prednisone 5 mg and loratadine 10 mg once daily. On day 5 postoperation, the patient developed pruritus and pain on generalized skin, erythema of abdomen and thighs, and skin chapping with exudation of right hand. The patient's WBC count was 12.7×109/L, N count was 8.6×109/L, and E count was 0.73×109/L. Delayed exfoliative dermatitis induced by iodixanol was considered. Dexamethasone 10 mg once daily was given by an IV infusion and calamine lotion was externally applied on the skin surface. After 4 days of treatments, the pruritus was improved and the patient developed excessively keratinization with pachulosis and crusting in the right hand and arm. Dexamethasone was stopped. After 14 days of treatments, the patient's WBC count was 10.6×109/L, N count was 6.6×109/L, and E count was 0.37×109/L; her skin returned to normal.Then, prednisone and loratadinetreatments were stopped. Key words: Iodixanol; Exfoliative dermatitis