Severe Cutaneous Adverse Reactions Following Intravenous Contrast: A Report of 2 Cases.

Dear Editor, With the advent of computer tomography (CT) imaging and cardiac catheterisation procedures, radiologic investigations employing the use of iodinated contrast media have experienced rapid growth in the last 20 years, with increasing numbers of patients receiving contrast.1 Most contrast-related adverse events (AE) are mild, including nausea, vomiting and urticaria. However, some are severe, resulting in renal impairment, shock and cardiac arrest. Of the severe cutaneous AEs, there are immediate reactions such as anaphylaxis, as well as delayed reactions such as maculopapular exanthems, drug reaction with eosinophilia and systemic symptoms (DRESS), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The use of high-osmolar contrast media (HOCM), which was prevalent from 1985 onwards, gave way to the safer low-osmolar contrast media (LOCM) in the early 1990s. This has led to a fall in the incidence of AEs attributed to contrast media from 6% to 8% to 0.2% to 0.7% as described by Cochran et al2 in 2001. Nevertheless, severe and delayed dermatologic manifestations can still result from contrasted scans. We report 2 patients who suffered from SJS/TEN overlap after receiving iodinated contrast.