Icodextrin-associated generalized exfoliative skin rash in a CAPD patient: a case-report

Abstract

BackgroundIcodextrin is a starch-derived, water soluble glucose polymer, which is used as an alternative to glucose in order to enhance dialytic fluid removal in peritoneal dialysis patients. Although the safety and efficacy of icodextrin is well-established, its use in everyday clinical practice has been associated with the appearance of skin rashes and other related skin reactions.Case presentationHerein, we report the rare case of a 91-year-old woman with a history of severe congestive heart failure, who initiated continuous ambulatory peritoneal dialysis with icodextrin-based dialysate solutions and 15 days after the initial exposure to icodextrin developed a generalized maculopapular and exfoliative skin rash extending over the back, torso and extremities. Discontinuation of icodextrin and oral therapy with low-dose methyl-prednisolone with quick dose tapering improved the skin lesions within the following days.ConclusionsThis case report highlights that skin hypersensitivity is a rare icodextrin-related adverse event that should be suspected in patients manifesting skin reactions typically within a few days or weeks after the initial exposure.

A Case of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome in a Patient Receiving Peritoneal Dialysis With Icodextrin Exposure

“…However, previous studies have shown that twice-daily icodextrin is not associated with a higher incidence of skin rash [ 5 , 6 ]. While the mechanism of the allergic phenomenon with icodextrin remains unclear, icodextrin’s chemical structure is similar to that of dextran, which has a high incidence of allergic reactions and anaphylaxis [ 7 , 8 ]. Cessation of icodextrin was the only necessary intervention to resolve skin rash; however, systemic steroids were used in a few severe cases [ 9 , 10 ].…”

Effects of 4% ıcodextrine, magnesium sulfate, and 0.9% sodium chloride on postoperative intraabdominal adhesions

“…It may interact with adefovir, blood pressure medications, digoxin, entecavir, insulin, metformin, or HIV or AIDS medications. It is not recommended for use in pregnant women 15 . Magnesium sulfate has side effects such as chest pain, respiratory distress, confusion, decreased reflexes, hypotension, and anxiety.…”

Icodextrin‐induced acute generalized exanthematous pustulosis in a patient with peritoneal dialysis

“…Icodextrin, a high molecular glucose polymer that can be slowly absorbed through the peritoneal cavity, is able to sustain peritoneal ultrafiltration for peritoneal dialysis patients with ultrafiltration failure (1). Although icodextrin has provided adequate ultrafiltration function without obvious adverse effect, several complications related to icodextrin are underestimated.…”

“…Icodextrin, a high molecular glucose polymer that can be slowly absorbed through the peritoneal cavity, is able to sustain peritoneal ultrafiltration for peritoneal dialysis patients with ultrafiltration failure. 1 Although icodextrin is relative safe and has provided better ultrafiltration function, several adverse reports related to icodextrin have been shown. It has been reported that incidence of icodextrin-associated complications ranged from 32.6% to 14.3%, including non-bacterial peritonitis (32.6%), upper respiratory tract infection (23.4%), and cutaneous rash (range from 2.3% to 18.9%).…”