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An unusual adverse reaction to iodine-based contrast agent

  • Mirta Menegatti
    Affiliations
    Department of Translational Medicine and Internal Medicine Division, Università del Piemonte Orientale, UPO, Novara, Italy
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  • Mario Pirisi
    Affiliations
    Department of Translational Medicine and Internal Medicine Division, Università del Piemonte Orientale, UPO, Novara, Italy
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  • Mattia Bellan
    Correspondence
    Corresponding author at: Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100 Novara, Italy. Tel.: +39 03213733966.
    Affiliations
    Department of Translational Medicine and Internal Medicine Division, Università del Piemonte Orientale, UPO, Novara, Italy
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Published:February 18, 2016DOI:https://doi.org/10.1016/j.ejim.2016.02.007

      1. Case description

      A 70-year-old woman was admitted to the Internal Medicine Division of an academic hospital because of persistent fever. She had a history of follicular lymphoma, diagnosed in 2001 and since then under remission, and of myelodisplastic syndrome. Review of systems did not reveal organ-specific complaints; moreover, chest X-rays and abdominal ultrasound did not show abnormal findings. Cultures and serology for common viruses were negative; renal function was normal. On the third hospital day, 24 h after a contrast-enhanced CT scan of thorax and abdomen (also reported as negative), the patient noticed a painful swelling in her upper neck region, worsened by swallowing. At physical examination, hyperaemia of the upper neck skin and bilateral diffuse submandibular gland enlargement were evident. The oral mucosa was normal. Soft tissue ultrasound examination of the submandibular areas was performed (Fig. 1).
      Figure thumbnail gr1
      Fig. 1The left panels show US and Color Doppler of the left submandibular gland at symptoms onset: Echo-Doppler assessment of salivary glands showed bilateral swelling, prominent internal low-echoic septa, increase in vascularisation and peri-glandular edema. On the right panels, the follow-up Echo-Doppler examination of the submandibular gland four days after sialoadenitis onset is reported, showing a full recovery. Right submandibular gland was characterized by similar findings.
      What is the diagnosis?

      2. Discussion

      The case is suggestive of contrast-induced sialoadenitis (iodide mumps). Iodide mumps is an uncommon adverse event induced by iodide-containing contrast agents, firstly described in 1956. Since then, only a few cases have been reported in literature [
      • Pérez-Valdivia M.A.
      • López-Mendoza
      • Toro-Prieto
      • Cabello-Chaves V.
      • Toro-Ramos M.
      • Martín-Herrera M.C.
      • et al.
      Iodide mumps.
      ]. This condition is characterized by a rapid onset, bilateral swelling of salivary glands following the administration of iodinated contrast agents. It can occur from minutes up to 5 days after the exposure. The pathogenesis is unclear, but seems to be linked to an idiosyncratic reaction or to be the result of the accumulation of iodide in the ductal system of the salivary glands. Usually, 98% of iodine is excreted by the kidney and the remaining 2% by the salivary, sweat and lacrimal glands; thus, impaired renal function is the main known risk factor for iodide mumps. However, it can occur also in patients with normal renal function [
      • Zhang G.
      • Li Y.
      • Zhang R.
      • Guo Y.
      • Ma Z.
      • Wang H.
      • et al.
      Acute submandibular swelling complicating arteriography with iodide contrast: a case report and literature review.
      ], as in the present case. Recurrence with successive exposure to iodide contrast is possible [
      • Panasoff J.
      • Nusem D.
      Iodide mumps.
      ]. Treatment may require analgesics, but a full recovery is expected within few days, as documented in our case by a follow-up ultrasound examination (Fig. 1 right panels). Though a self-limiting, benign condition, prompt recognition of contrast-induced sialoadenitis is important to avoid unnecessary diagnostic investigations.

      Conflict of interests

      The authors have no conflict of interest to declare.

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