Iohexol
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Anaphylactoid reaction with myocardial infarction: case report A 43-year-old man developed an anaphylactoid reaction with myocardial infarction following administration of iohexol [Omnipaque] contrast medium. The man received an IV bolus injection of iohexol 100mL into the left antecubital vein prior to multislice computed tomography (MSCT) coronarography. He reported a pain in his neck with transient chest pain lasting for a few minutes, with a similar pain in his hands followed by a feeling of "drowning" [time to reaction onset not stated]. He had shivers, difficulty breathing, weakness, diaphoresis and facial redness. He was slightly hypotensive with an oxygen saturation of 68%; ST elevation in V1–V4, and ST depression in D2, D3, avF, were evident on ECG. Auscultation revealed decreased breath sounds with inspiratory crackles, more pronounced on the left side. Volume replacement, epinephrine [adrenaline], hydrocortisone and oxygen were administered. The man’s oxygen saturation improved; however, on admission, he was dysphonic and pale with "head fullness" and a dry irritating cough. A patch test was performed with an iohexol 300 mg/mL water solution. After 20 minutes, he developed a 3+ positive reaction with a circle diameter of 14mm. His serum tryptase levels peaked at 55 µg/L and his urinary histamine level remained elevated at 206ng for 24 hours. His WBC count and sedimentation rate were 10.0 and 24, respectively. He had elevated levels of troponin, LDH and creatine kinase, which normalised on hospital day 2. Multiple spot-like consolidations and an increased left chamber were evident on chest x-ray. A full improvement was noted on day 3, with a normal heart size and no active pathological lung changes. Small tricuspid regurgitation 1+ and an ejection fraction of 65% were observed on ultrasound. An anaphylactic reaction to iohexol contrast was suspected. He was discharged after 7 days of hospitalisation with normal ECG and x-ray findings. Andjelic S, et al. Myocardial infarction as an anaphylactoid reaction to iodine contrast. Revue Francaise d’Allergologie 50: 579-583, No. 7, Nov 2010. Available 803048303 from: URL: http://dx.doi.org/10.1016/j.reval.2010.03.003 - Serbia
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Reactions 22 Jan 2011 No. 1335
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