肾功能衰竭患者碘造影后局部面部大疱性皮疹
Localized Facial Bullous Eruption Following Iodinated Contrast in a Patient With Renal Failure.
摘要(中文译文)
碘对比剂（ICM）可诱发迟发型超敏反应，但局限性复发性大疱性皮疹极为罕见。本文报道一例51岁男性终末期肾病（ESRD）患者，在因血管介入治疗反复接受静脉ICM后，出现复发性、高度局限性的面部大疱性皮肤病。其初次反应为弥漫性面部潮红，随着后续再次暴露，演变为严重的、解剖位置固定的面部水疱形成，且严格避开口腔黏膜，最终消退为严重的炎症后色素沉着。本病例呈现独特的诊断重叠：严格的解剖位置复发性是固定性药疹的临床标志，而ESRD背景下水疱形成的严重程度则提示类似于碘疹的协同毒代动力学机制。患者严重的肾功能损害很可能导致对比剂清除延迟，造成大量全身性碘负荷，从而放大了半抗原驱动的局部炎症反应。临床医生必须识别ICM不断演变的超敏反应模式，因为肾功能不全时清除延迟可显著加剧局部T细胞介导的皮肤反应，若未及时识别并避免致病药物，可导致严重的色素异常。
Abstract
Iodinated contrast media (ICM) can induce delayed hypersensitivity reactions, but localized recurrent bullous eruptions are exceedingly rare. We present the case of a 51-year-old male with end-stage renal disease (ESRD) who developed a recurrent, highly localized bullous facial dermatosis following repeated intravenous ICM administration for vascular interventions. His initial reaction of diffuse facial flushing evolved with subsequent exposures into severe, anatomically fixed facial blistering that strictly spared the oral mucosa, ultimately resolving into profound post-inflammatory hyperpigmentation. This case presents a unique diagnostic overlap: the strict anatomic recurrence represents the clinical hallmark of a fixed drug eruption, while the severity of the blistering in the setting of ESRD suggests a synergistic toxicokinetic mechanism akin to iododerma. The patient's profound renal impairment likely caused delayed contrast clearance, resulting in a massive systemic iodine load that amplified the hapten-driven localized inflammatory response. Clinicians must recognize evolving hypersensitivity patterns to ICM, as delayed clearance in renal dysfunction can drastically exacerbate localized T-cell-mediated cutaneous reactions, leading to severe dyspigmentation if the offending agent is not promptly identified and avoided.
如何引用
AMA
Jared R Zhang, Annie Cherner, Mitchell W Cox, Christine L Shokrzadeh. Localized Facial Bullous Eruption Following Iodinated Contrast in a Patient With Renal Failure.. Cureus. 2026; doi:10.7759/cureus.110513.
APA
Jared R Zhang, Annie Cherner, Mitchell W Cox, Christine L Shokrzadeh (2026). Localized Facial Bullous Eruption Following Iodinated Contrast in a Patient With Renal Failure.. Cureus. https://doi.org/10.7759/cureus.110513
GB/T 7714
Jared R Zhang, Annie Cherner, Mitchell W Cox, Christine L Shokrzadeh. Localized Facial Bullous Eruption Following Iodinated Contrast in a Patient With Renal Failure.[J]. Cureus, 2026 doi:10.7759/cureus.110513.
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