碘克沙醇致迟发性剥脱性皮炎

Delayed exfoliative dermatitis induced by iodixanol

1例74岁女性患者行PCI，术中使用碘克沙醇220ml。患者术前WBC8．6×10^9／L，中性粒细胞计数（N）4．2×10^9／L，嗜酸粒细胞计数（E）0．36×10^9／L，scr122μmol／L。术后第4天患者出现背部及右上肢近端红斑、丘疹和双手肿胀等症状。给予泼尼松（5mg，1次／d）和氯雷他定（10mg，1次／d）口服。术后第5天患者全身皮肤瘙痒、疼痛不适，胸背部、双上肢、腹部及大腿部皮肤可见红色丘疹，右手皮肤皲裂伴液体渗出，WBC12．7×10^9/L，N8．6×10^9／L，E0．73×10^9／L。考虑为碘克沙醇引起的迟发性过敏反应。加用地塞米松10mg静脉滴注、1次／d，炉甘石洗剂外敷。4d后患者瘙痒好转，右手及右臂皮肤过度角质化、粗糙伴脱屑，停用地塞米松。2周后，患者皮肤恢复正常，WBC10．6×10^9／L，N6．6×10^9／L，E0．37×10^9／L，停用泼尼松和氯雷他定。

A 74-year-old female patient with coronary artery disease underwent primary percutaneous coronary intervention and received iodixanol 220 ml during the operation. Before the intervention, the patient＇s white blood cell （WBC） count was 8.6 × 10^9/L, neutrophil （N） count was 4.2 × 10^9/L, eosiuophil （E） count was 0.36×10^9/L, and serum creatinine level was 122 μmol/L. On day 4 postoperation, the patient developed erythema of back and right upper limb, swelling of hands （ especially the right hand）. She was given prednisone 5 mg and loratadine 10 mg once daily. On day 5 postoperation, the patient developed pruritus and pain on generalized skin, erythema of abdomen and thighs, and skin chapping with exudation of right hand. The patient＇s WBC count was 12.7 × 10^9/L, N count was 8.6 × 10^9/ L, and E count was 0.73 × 10^9/L. Delayed exfoliative dermatitis induced by iodixanol was considered. Dexamethasone 10 mg once daily was given by an IV infusion and calamine lotion was externally applied on the skin surface. After 4 days of treatments, the pruritus was improved and the patient developed excessively keratinization with pachulosis and crusting in the right hand and arm. Dexamethasone was stopped. After 14 days of treatments, the patient＇s WBC count was 10.6× 10^9/L, N count was 6.6 × 10^9/L, and E count was 0.37×10^9/L; her skin returned to normal. Then, prednisone and loratadinetreatments were stopped.