Anaphylaxis to gadobutrol and gadoterate meglumine in a patient with low grade astrocytoma

Method A 58-year old woman with low grade astrocytoma, who had previously tolerated Gadolinium-based contrasts, was diagnosed with anaphylaxis to Gadobutrol by history of anaphylaxis after intravenous administration and positive skin testing. For these reasons Gadobutrol administration was banned and was given a premedication protocol (steroids and antihistamines) if the patient will require future administrations of other Gadolinium-based agents. However, one year later, despite premedication the patient presented with pruritus and hives disseminated, breathlessness, dizziness and hypotension two minutes after administration of Gadoterate Meglumine in a control brain MRI. Skin testing with Gadoterate meglumine, and Gadopentetic acid was carried out. Histamine and isotonic saline were used as positive and negative controls respectively.