Jennifer Toh

Successful Graded Dose Challenge to Iodixanol Radiocontrast Media in a Patient With Delayed Anaphylaxis to Iohexol

We present a case of an 82-year-old male with known radiocontrast media (RCM) hypersensitivity who was admitted to our hospital with gangrene of his right toe. The plan for revascularization of his lower extremity required an angiogram. This presented a management challenge as the patient had experienced 2 episodes of delayed anaphylaxis to Omnipaque (iohexol) RCM, and based on a literature review, there was no known or established precedent on a safe procedure in these situations. The patient was premedicated and given a graded dose challenge of an alternative RCM (iodixanol) prior to the radiographic study. He was given 1% of the total expected dose 1 hour before to the procedure and an additional 10% for the 30 minutes prior. He was then given the final dose in the operating room. Following angiogram, the patient was monitored for 18 hours in the postanesthesia care unit, with no adverse reactions. He was placed on a prednisone taper for 1 week, with daily diphenhydramine. The patient remained asymptomatic throughout the hospital course. This novel approach to RCM hypersensitivity management lends itself to a hope that graded dose challenges may play a greater role in the management of these patients.

Noninfectious Enterocolitis as Initial Presentation of Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) is a rare primary immune deficiency that is characterized by repeated infections with bacterial and fungal pathogens, as well as the formation of granulomas in tissue. It is a disorder of the NADPH oxidase system, culminating in an inability of the phagocyte to generate superoxide, leading to the defective killing of pathogenic organisms. We report the case of a 10-month-old male infant who presented with prolonged fever of unknown origin, persistent diarrhea, and failure to thrive. An extensive evaluation was nondiagnostic until CGD was suspected when a jejunal biopsy repeated for the third time showed the presence of a granuloma.

A case of chronic contact dermatitis resulting from the use of blue hair dye.

A 45-year-old female with a history of allergic rhinitis presented to our clinic with a history of several years of generalized pruritus and intermittent erythematous rashes, primarily on the scalp, face, and neck. These symptoms began when she started to dye her hair blue. Exacerbations would occur soon after repeated dyeing. She was unable to report or bring in a specific brand of dye, as she had been to multiple hair salons throughout the community and used multiple products, but she confirmed that all dyes were blue. Patch testing with our site’s baseline and supplemental series was performed with Finn Chambers® on Scanpor® tape, according to ICDRG guidelines. The only positive reactions (2+) were to Disperse Blue 106 at the day (D) 2 and D6 readings (Fig. 1). All other haptens, including PPD, gave negative results. The patient was instructed to avoid all products containing blue dye, but she continues to use the same hair products and still suffers from scalp dermatitis.