Generalized Bullous Fixed Drug Eruption to Iodinated Contrast Media in Skin of Color

      A 69-year-old Malay woman presented with a widespread painful blistering rash, which had first begun over her neck and trunk, a few hours after a computed tomography scan performed with 90 mL of iohexol contrast for surveillance of sigmoid adenocarcinoma. Examination was notable for multiple circular hyperpigmented patches with inlying blisters and well-demarcated erosions involving her upper lip, neck, abdomen, and lower extremities (Figures 1 and 2). The total area of detachable epidermis was approximately 25%. Despite extensive cutaneous involvement, she was otherwise systemically well and clinical parameters were within normal limits. Further probing elicited a history of similar eruptions in the past, localized to a few spots on her thighs, which were also involved this time. Strikingly, each of these episodes occurred within 24 hours following iodinated contrast media administration and was self-limiting in nature.
      Figure 1
      Figure 1Multiple well-demarcated erosions over the chest and abdomen, with flaccid bullae over the right forearm, pubic area, and right thigh.
      Figure 2
      Figure 2Circular erosions over the thighs with surrounding denuded epidermis.
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        • Anderson HJ
        • Lee JB.
        A review of fixed drug eruption with a special focus on generalized bullous fixed drug eruption.
        Medicina (Kaunas). 2021; 57: 925
        • Cho YT
        • Lin JW
        • Chen YC
        • et al.
        Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features.
        J Am Acad Dermatol. 2014; 70: 539-548
        • Mitre V
        • Applebaum DS
        • Albahrani Y
        • Hsu S.
        Generalized bullous fixed drug eruption imitating toxic epidermal necrolysis: a case report and literature review.
        Dermatol Online J. 2017; 23
        • Dodiuk-Gad RP
        • Chung WH
        • Valeyrie-Allanore L
        • Shear NH.
        Stevens–Johnson syndrome and toxic epidermal necrolysis: an update.
        Am J Clin Dermatol. 2015; 16: 475-493
        • Lee CH
        • Chen YC
        • Cho YT
        • Chang CY
        • Chu CY.
        Fixed-drug eruption: a retrospective study in a single referral center in northern Taiwan.
        Dermatol Sin. 2012; 30: 11-15
        • Dharamsi FM
        • Michener MD
        • Dharamsi JW.
        Bullous fixed drug eruption masquerading as recurrent Stevens Johnson syndrome.
        J Emerg Med. 2015; 48: 551-554
        • Gavin M
        • Sharp L
        • Walker K
        • Behrens E
        • Akin R
        • Stetson CL.
        Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome.
        Proc Bayl Univ Med Cent. 2019; 32: 601-602
        • Patel S
        • John AM
        • Handler MZ
        • Schwartz RA.
        Fixed drug eruptions: an update, emphasizing the potentially lethal generalized bullous fixed drug eruption.
        Am J Clin Dermatol. 2020; 21: 393-399
        • Khoo AKM
        • Foo CL.
        Toxic epidermal necrolysis in a burns centre: A 6-year review.
        Burns. 1996; 22: 275-278
        • Finkelstein Y
        • Soon GS
        • Acuna P
        • et al.
        Recurrence and Outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.
        Pediatrics. 2011; 128: 723-728
        • Lim YL
        • Ting Tan E Sern
        Cutaneous adverse drug reactions.
        Asian Skin. 2015; : 479-481
        • Lipowicz S
        • Sekula P
        • Ingen-Housz-Oro S
        • et al.
        Prognosis of generalized bullous fixed drug eruption: comparison with Stevens–Johnson syndrome and toxic epidermal necrolysis.
        Br J Dermatol. 2013; 168: 726-732
        • Barootes HC
        • Peebles ER
        • Matsui D
        • Rieder M
        • Abuzgaia A
        • Mohammed JA.
        Severe generalized bullous fixed drug eruption treated with cyclosporine: a case report and literature review.
        Case Rep Dermatol. 2021; 13: 154-163
        • Andrade P
        • Brinca A
        • Gonçalo M.
        Patch testing in fixed drug eruptions-a 20-year review.
        Contact Dermatitis. 2011; 65: 195-201