SHM Converge Scientific Abstract ePoster Gallery-Rare Rash in a Patient With Renal Dysfunction

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This case describes a 46-year-old woman with hypertension and end-stage renal disease who developed a rapidly progressive, painful, pruritic rash shortly after undergoing a fistulogram for a nonfunctioning fistula. Within hours, lesions appeared on the legs, torso, upper extremities, and oral mucosa. Initial concern included infectious and inflammatory causes such as VZV/HSV, fungal infection, bullous dermatosis, or vasculitis.<br /><br />Her evaluation showed mild leukocytosis and elevated ESR, but otherwise stable ESRD-related labs and normal lactate. Dermatology and infectious disease were consulted. She was initially treated empirically with vancomycin and a dose of caspofungin while workup was pending. Skin biopsy showed a neutrophilic infiltrate with haloed structures suggestive of fungal infection, but fungal stains were negative. Extensive infectious testing, including cultures and serologies for multiple pathogens, was negative.<br /><br />Given the close temporal relationship to iodinated contrast exposure during the fistulogram and her renal dysfunction, iododerma was suspected. This was supported by markedly elevated serum iodine and urine iodine levels. The rash was treated with topical steroids, and dialysis was continued throughout hospitalization. Although the eruption worsened during the first week, it improved significantly by two weeks and was nearly resolved by two months.<br /><br />Iododerma is a rare and heterogeneous skin eruption caused by iodine exposure, most often after iodinated contrast in patients with renal impairment. It can present as acneiform, pustular, hemorrhagic, bullous, or nodular lesions and may mimic infection or other dermatoses. Diagnosis relies on exposure history, clinical findings, and elevated iodine levels. Treatment is mainly supportive, including steroids and dialysis when indicated. Prognosis is generally good, though scarring may occur.

Asset Subtitle

Nabeeha Ahmad

Meta Tag

Author List Allison Rossetti, Nabeeha Ahmad

Category Clinical Vignettes

Concept Iododerma

Concept Iodine Exposure

Concept Iodinated Contrast

Concept Renal Dysfunction

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Nabeeha Ahmad

Track Adult

Keywords

iododerma

iodinated contrast

renal impairment

end-stage renal disease

fistulogram

painful rash

pruritic eruption

skin biopsy

elevated iodine levels

dialysis

Iododerma

Iodine Exposure

Iodinated Contrast

Renal Dysfunction

Biopsy