A cutaneous disease with multisystem involvement: hypomelanosis of Ito may be associated with proteinuria, focal segmental glomerulosclerosis and end-stage renal disease.

Although coronary artery spasm is diagnosed by angiography using provocative drugs like Acetylcholine and Ergonovine, an exercise test following hyperventilation is an equivalent non-invasive test to diagnose this condition [2]. Thus, a negative provocative stress test ruled out the possibility of vasospastic angina in this patient. The Naranjo probability score confirmed an adverse drug reaction (Score 6) [3]. There is no previous association of iron sucrose with coronary vasospasm. In the Fenton and Haber–Weiss reaction, free metal ions like iron facilitate the production of toxic hydroxyl radicals from superoxide radicals [4], which can inhibit the synthesis of prostacyclin, influencing vessel tone [5]. This is a probable explanation for coronary spasm precipitated by the drug in our patient. The use of iron sucrose has addressed issues of anaphylaxis and infection to a large extent. Recommendation for higher doses and its good tolerability reduces the visits for iron treatment. However, it rarely poses potential hazards, the possibility of coronary artery spasm being one such complication.