IODODERMA AND SIALADENOPATHY AFTER IODINATED CONTRAST MEDIA EXPOSURE

Abstract

Introduction Iodinated contrast media (ICM) exposure may elicit a variety of rare adverse reactions, including iododerma and iodine-related sialadenopathy (iodide mumps). This patient develops both after ICM exposure. Case Description A 52-year-old AA female with granulomatosis with polyangiitis (GPA) on hemodialysis (HD) presents to the hospital with one-day onset of bilateral submandibular swelling. She had a CT TAP with contrast a day ago for renal transplant evaluation. In the ED, CT neck with contrast is significant for bilateral enlargement and enhancement of the submandibular glands. The next day, she develops bullous lesions on her extremities and face. Physical exam is pertinent for tense bullae on extremities and face and tender submandibular swelling. Skin biopsy is unrevealing. Serum iodine level is 177,360 (normal 52-109) mcg/L. Clinical diagnoses of iododerma and iodide mumps are made, and the patient is started on IV dexamethasone and sent for HD. Sialadenopathy resolves in a week, and skin lesions resolve over the next three weeks. Discussion Iodide mumps and iododerma are rare complications of ICM. The mechanisms are not believed to be immune-mediated. Both reactions are likely secondary to excess accumulation of iodide in the body. Iodine concentration rapidly increases with impaired renal function; 98% of iodine is renally eliminated and the rest via salivary and sweat glands. Both reactions are generally benign and self-limiting; prior cases have utilized corticosteroids and HD, but it is unclear if these improve outcomes. This is a rare case of a patient with GPA on HD who develops two uncommon reactions together after ICM. Iodinated contrast media (ICM) exposure may elicit a variety of rare adverse reactions, including iododerma and iodine-related sialadenopathy (iodide mumps). This patient develops both after ICM exposure. A 52-year-old AA female with granulomatosis with polyangiitis (GPA) on hemodialysis (HD) presents to the hospital with one-day onset of bilateral submandibular swelling. She had a CT TAP with contrast a day ago for renal transplant evaluation. In the ED, CT neck with contrast is significant for bilateral enlargement and enhancement of the submandibular glands. The next day, she develops bullous lesions on her extremities and face. Physical exam is pertinent for tense bullae on extremities and face and tender submandibular swelling. Skin biopsy is unrevealing. Serum iodine level is 177,360 (normal 52-109) mcg/L. Clinical diagnoses of iododerma and iodide mumps are made, and the patient is started on IV dexamethasone and sent for HD. Sialadenopathy resolves in a week, and skin lesions resolve over the next three weeks. Iodide mumps and iododerma are rare complications of ICM. The mechanisms are not believed to be immune-mediated. Both reactions are likely secondary to excess accumulation of iodide in the body. Iodine concentration rapidly increases with impaired renal function; 98% of iodine is renally eliminated and the rest via salivary and sweat glands. Both reactions are generally benign and self-limiting; prior cases have utilized corticosteroids and HD, but it is unclear if these improve outcomes. This is a rare case of a patient with GPA on HD who develops two uncommon reactions together after ICM.