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BMC Pulmonary Medicine

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Open Access 01-12-2024 | Lymphoma | Case Report

Transient pulmonary and gastric bleeding after iopamidol administration in a patient with marginal zone lymphoma: a case report

Authors: Weixian Xu, Miaozhen Chen, Songtao Liu, Yi Su, Yunhai Zhang

Published in: BMC Pulmonary Medicine | Issue 1/2024

Abstract

Background

Iopamidol is a non-ionic, water-soluble iodine contrast agent that is considered safe for intravenous or intra-arterial administration and is widely used both in the general population and in patients undergoing oncological treatment. While adverse reactions to iopamidol have been documented, to date, no pulmonary and gastric hemorrhages induced by iopamidol have been reported in oncology patients. We report the first case of this complication.

Case presentation

We report the case of a 60-year-old woman with marginal zone lymphoma who was receiving antineoplastic therapy. As part of the investigation for the condition, she underwent chest enhancement CT with iopamidol. Shortly thereafter(within five minutes), she experienced hemoptysis and hematemesis. She was intubated and admitted to the intensive care unit. Pre- and post-contrast images demonstrated the course of the hemorrhage. Flexible bronchoscopy and gastroscopy on the following day showed no active bleeding, and the patient recovered completely after antiallergy treatment. We speculate that contrast-induced hypersensitivity was the most likely cause of the transient pulmonary and gastric bleeding.

Conclusion

Although rare, the complications of iopamidol, which may cause allergic reactions in the lungs and stomach, should be considered.

Filatov DN, Cherkavskaia OV, Korobkova IZ. [Iopamidol is a safe choice in the practice of diagnostic imaging]. Vestn Rentgenol Radiol. 2011(3):69–72.

Meucci E, Radice A, Fassio F, Sibilio M, Iorno M, Testi S, et al. Diagnostic approach to hypersensitivity reactions to iodinated contrast media: a single-center experience on 98 patients. Eur Ann Allergy Clin Immunol. 2020;52(5):220–9. https://doi.org/10.23822/EurAnnACI.1764-1489.129.CrossRefPubMed

Suh YJ, Yoon SH, Hong H, Hahn S, Kang DY, Kang HR, et al. Acute adverse reactions to nonionic iodinated contrast media: a Meta-analysis. Invest Radiol. 2019;54(9):589–99. https://doi.org/10.1097/RLI.0000000000000568.CrossRefPubMed

Cutroneo P, Polimeni G, Curcuruto R, Calapai G, Caputi AP. Adverse reactions to contrast media: an analysis from spontaneous reporting data. Pharmacol Res. 2007;56(1):35–41. https://doi.org/10.1016/j.phrs.2007.03.003.CrossRefPubMed

Paul RE, George G. Fatal non-cardiogenic pulmonary oedema after intravenous non-ionic radiographic contrast. Lancet. 2002;359(9311):1037–8. https://doi.org/10.1016/s0140-6736(02)08068-6.CrossRefPubMed

Dawson P, Howell M. The non-ionic dimers: a new class of contrast agents. Br J Radiol. 1986;59(706):987–91. https://doi.org/10.1259/0007-1285-59-706-987.CrossRefPubMed

Jiang W, Hu S, Che D, An H, Liu R. A mast-cell-specific receptor mediates Iopamidol induced immediate IgE-independent anaphylactoid reactions. Int Immunopharmacol. 2019;75:105800. https://doi.org/10.1016/j.intimp.2019.105800.CrossRefPubMed

Brockow K, Romano A, Aberer W, Bircher AJ, Barbaud A, Bonadonna P, et al. Skin testing in patients with hypersensitivity reactions to iodinated contrast media - a European multicenter study. Allergy. 2009;64(2):234–41. https://doi.org/10.1111/j.1398-9995.2008.01832.x.CrossRefPubMed

Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621–8. https://doi.org/10.1148/radiology.175.3.2343107.CrossRefPubMed

10.

Laroche D, Aimone-Gastin I, Dubois F, Huet H, Gérard P, Vergnaud MC, et al. Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology. 1998;209(1):183–90. https://doi.org/10.1148/radiology.209.1.9769830.CrossRefPubMed

11.

Salas M, Gomez F, Fernandez TD, Doña I, Aranda A, Ariza A, et al. Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy. 2013;68(9):1203–6. https://doi.org/10.1111/all.12214.CrossRefPubMed

12.

Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med. 2003;139(8):683–93. https://doi.org/10.7326/0003-4819-139-8-200310210-00012.CrossRefPubMed

13.

Dewachter P, Mouton-Faivre C, Felden F. Allergy and contrast media. Allergy. 2001;56(3):250–1. https://doi.org/10.1034/j.1398-9995.2001.056003250.x.CrossRefPubMed

14.

Kim MH, Lee SY, Lee SE, Yang MS, Jung JW, Park CM, et al. Anaphylaxis to iodinated contrast media: clinical characteristics related with development of anaphylactic shock. PLoS ONE. 2014;9(6):e100154. https://doi.org/10.1371/journal.pone.0100154.CrossRefPubMedPubMedCentral

15.

Kvedariene V, Martins P, Rouanet L, Demoly P. Diagnosis of iodinated contrast media hypersensitivity: results of a 6-year period. Clin Exp Allergy. 2006;36(8):1072–7. https://doi.org/10.1111/j.1365-2222.2006.02532.x.CrossRefPubMed

16.

Prieto-García A, Tomás M, Pineda R, Tornero P, Herrero T, Fuentes V, et al. Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing. J Investig Allergol Clin Immunol. 2013;23(3):183–9.PubMed

17.

Trcka J, Schmidt C, Seitz CS, Bröcker EB, Gross GE, Trautmann A. Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? AJR Am J Roentgenol. 2008;190(3):666–70. https://doi.org/10.2214/AJR.07.2872.CrossRefPubMed

18.

Morales-Cabeza C, Roa-Medellín D, Torrado I, De Barrio M, Fernández-álvarez C, Montes-Aceñero JF, et al. Immediate reactions to iodinated contrast media. Ann Allergy Asthma Immunol. 2017;119(6):553–7. https://doi.org/10.1016/j.anai.2017.08.014.CrossRefPubMed

19.

Uyar M, Elbek O, Bayram N, Ekiz S, Bakir K, Dikensoy O. Diffuse alveolar haemorrhage due to 5-nitroimidazole treatment. Respirology. 2009;14(4):612–3. https://doi.org/10.1111/j.1440-1843.2009.01530.x.CrossRefPubMed

20.

Vizzardi E, D’Aloia A, Zanini G, Antonioli E, Pedrinazzi C, Raddino R, et al. A case report of alveolar haemorrhage associated with severe thrombocytopenia induced by abciximab infusion in a patient with an acute coronary syndrome. Intern Emerg Med. 2008;3(4):345–7. https://doi.org/10.1007/s11739-008-0167-6.CrossRefPubMed

21.

Turan T, Sayın MR, Kul S, Akyüz AR. Be aware of misdiagnosis tied to COVID-19 focusing: a case report of abciximab-induced alveolar haemorrhage thought to be SARS-CoV-2 in a patient with ST-segment elevation myocardial infarction. Eur Heart J Case Rep. 2020;4(6):1–6. https://doi.org/10.1093/ehjcr/ytaa505.CrossRefPubMedPubMedCentral

22.

Seto R, Yamada H, Wada H, Osawa M, Nagao T, Nakano Y. Diffuse alveolar haemorrhage may be associated with intravitreal injection of bevacizumab in a patient with systemic risk factors. BMJ Case Rep. 2011;2011. https://doi.org/10.1136/bcr.08.2010.3224.

23.

Tahir W, Hakeem A, Baker R, Ahmad N. Diffuse Alveolar haemorrhage: A fatal complication after alemtuzumab induction therapy in renal transplantation. Transplant Proc. 2015;47(1):151-4. https://doi.org/10.1016/j.transproceed.2014.10.037.

24.

Ohtsuka M, Yamashita Y, Doi M, Hasegawa S. Propylthiouracil-induced alveolar haemorrhage associated with antineutrophil cytoplasmic antibody. Eur Respir J. 1997;10(6):1405–7.CrossRefPubMed

25.

Yamauchi K, Sata M, Machiya J, Osaka D, Wada T, Abe S, et al. Antineutrophil cytoplasmic antibody positive alveolar haemorrhage during propylthiouracil therapy for hyperthyroidism. Respirology. 2003;8(4):532–5. https://doi.org/10.1046/j.1440-1843.2003.00499.x.CrossRefPubMed

26.

El-Fakih R, Chehab BM, Shaver T. Thionamide-induced vasculitis: a case of alveolar haemorrhage secondary to propylthiouracil. J Intern Med. 2008;264(6):610–2. https://doi.org/10.1111/j.1365-2796.2008.01990.x.CrossRefPubMed

27.

Arai N, Nemoto K, Oh-Ishi S, Nonaka M, Hayashihara K, Saito T. Methimazole-induced ANCA-associated vasculitis with diffuse alveolar haemorrhage. Respirol Case Rep. 2018;6(5):e315. https://doi.org/10.1002/rcr2.315.CrossRef

28.

Perri D, Cole DE, Friedman O, Piliotis E, Mintz S, Adhikari NK. Azathioprine and diffuse alveolar haemorrhage: the pharmacogenetics of thiopurine methyltransferase. Eur Respir J. 2007;30(5):1014–7. https://doi.org/10.1183/09031936.00026107.CrossRefPubMed

29.

Tanawuttiwat T, Harindhanavudhi T, Hanif S, Sahloul MZ. Amiodarone-induced alveolar haemorrhage: a rare complication of a common medication. Heart Lung Circ. 2010;19(7):435–7. https://doi.org/10.1016/j.hlc.2010.01.008.CrossRefPubMed

30.

Saeed J, Waqas QA, Khan UI, Abdullah H. Amiodarone-induced diffuse alveolar haemorrhage: a rare but potentially life-threatening complication of a commonly prescribed medication. BMJ Case Rep. 2019;12(10). https://doi.org/10.1136/bcr-2019-232149.

31.

Mengar M, Gupta N, Chakrabarti S, Aggarwal V, Shah K, Ish P. Cocaine abuse induced diffuse alveolar haemorrhage: a rare entity. Monaldi Arch Chest Dis. 2020;90(1). https://doi.org/10.4081/monaldi.2020.1191.

32.

Villeneuve T, Prevot G, Le Borgne A, Colombat M, Collot S, Ruiz S, et al. Diffuse alveolar haemorrhage secondary to e-cigarette vaping associated lung injury (EVALI) in a young European consumer. Eur Respir J. 2020;56(1). https://doi.org/10.1183/13993003.00143-2020.

33.

Kalinczuk L, Lubiszewska B, Demkow M. Normal chest radiograph and ground glass opacities on a thoracic computed tomographic scan in a patient with diffuse alveolar haemorrhage due to dual antiplatelet therapy prescribed after patent foramen ovale percutaneous device closure. Eur Heart J. 2011;32(23):2988. https://doi.org/10.1093/eurheartj/ehr353.CrossRefPubMed

34.

Kelchen P, Jamous F, Huntington MK. Diffuse alveolar haemorrhage associated with aerosol propellant use. BMJ Case Rep. 2013;2013. https://doi.org/10.1136/bcr-2013-200022.

35.

Grassin F, André M, Rallec B, Combes E, Vinsonneau U, Paleiron N. [Fatal alveolar haemorrhage following a bang of cannabis]. Rev Mal Respir. 2011;28(7):919–23. https://doi.org/10.1016/j.rmr.2011.05.005.CrossRefPubMed

36.

Nakamura T, Watari T, Tokuda Y. Over-the-counter drug-induced lung injuries with both diffuse alveolar haemorrhage and diffuse alveolar damage. BMJ Case Rep. 2018;2018. https://doi.org/10.1136/bcr-2018-226626.

Title: Transient pulmonary and gastric bleeding after iopamidol administration in a patient with marginal zone lymphoma: a case report
Authors: Weixian Xu
Miaozhen Chen
Songtao Liu
Yi Su
Yunhai Zhang
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Lymphoma
Pulmonary Hemorrhage
Propylthiouracil
Published in: BMC Pulmonary Medicine / Issue 1/2024
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-024-02993-z

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Abstract

Background

Case presentation

Conclusion

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