Vegetating Iododerma with Fatal Outcome

Abstract

A 65-year-old woman on whom a cardiac catherization using iodine contrast had been performed developed 5 days later acute renal failure, respiratory insufficiency and cutaneous lesions consisting of two great vegetating masses located on both cheeks and pustular vesicular lesions on the extremities. A fortnight later, the patient died. We would like to stress this case because of the exceptional nature of vegetating iododerma at present, and the importance of recognizing a possibly fatal disease.

Drug-Induced Acneiform Eruption

“…It has been reported extensively in the literature since 1854. [81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] The lesions may present as papules, vesicles, and pustules but also as erythematous, urticarial, furuncular, carbuncular, bullous, and sterile vegetating lesions that may ulcerate. Lesions appear on the seborrheic regions (face, neck, and back), but they may be more widespread and involve the whole body.…”

“…[85] Iododermas occur mostly in patients with renal insufficiency as iodine is cleared by the kidneys. They have been reported after various situations including intravenous injection of iodinated contrast medium, [89] cardiac catheterization, [93] urography, [84] lymphography, [85] iodized salt consumption, [82] potassium iodide intake for thyroid protection, [86] and amiodarone intake. [92] Histology shows a dense inflammatory infiltrate composed of neutrophils and eosinophils in the dermis.…”

A practical guide to diagnose lesser-known immediate and delayed contrast media-induced adverse cutaneous reactions

“…Iododerma after high-dose urography in an oliguric patient was reported by Heydenreich and Larsen [66]. Renal failure seems to be an important factor that may promote iododerma [66][67][68].…”

“…Despite iodinated CM being frequently used worldwide, iododerma is rarely observed in concert with iodinated CM injection. Only a few case reports have been published [65][66][67][68][69][70]. One death has been reported [68].…”

Vegetative Plaques and Hemorrhagic Pustules

“…2 Although usually self-limited, iododerma has been fatal and may cause considerable disfigurement. 3 The diagnosis of iododerma is dependent on the clinical evaluation and exposure history because there is no pathognomonic laboratory or histopathologic finding 4 ; however, elevated blood iodine levels and histologic findings may be useful in making the diagnosis. Histologically, a neutrophilic infiltrate in the dermis with exocytosis and intraepidermal abscess formation is most commonly observed; papillomatosis may be seen in longstanding lesions.…”