Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Associated With Iodinated Contrast Media: A Case Report with Fatal Outcome and Literature Review

Abstract

An adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as any harmful and undesired response to a drug that occurs at doses normally used in humans for prophylaxis, diagnosis, treatment of a disease, or to modify a physiological function (1). Cutaneous adverse drug reactions (CADRs), or pharmacodermias, are a type of ADR that manifest in the skin, mucous membranes, and/or appendages (1). Their broad clinical presentation can pose a diagnostic challenge. Currently, with the constant development of new diagnostic and therapeutic options, exposure to various types of medications has increased, necessitating a high index of suspicion and the ability to detect any manifestation of a potential ADR. Furthermore, there is limited information on ADRs related to iodinated contrast media, as non-immediate hypersensitivity reactions are estimated to occur in only 0.5% to 3% of exposed patients, with even fewer reported cases of severe, potentially life-threatening reactions. We present the case of a patient with chronic exposure to medications for managing comorbidities, who developed a drug reaction with eosinophilia and systemic symptoms (DRESS) following exposure to iodinated contrast media as part of his diagnostic and therapeutic workup, ultimately leading to his death.