2009 Southern Regional Meeting Abstracts

Case Report: Radiocontrast media are considered generally safe and most reactions are mild, however serious reaction can occur. Gadolinium is commonly used for MRI imaging and in the past was considered a benign compound. Although rare, gadolinium can cause serious adverse reactions as illustrated by the case described below.
A 48 year female with a past medical history of hypertension was admitted with lip swelling, left sided tingling and numbness of her face. The patient was presently taking an angiotensin converting enzyme inhibitor (ACE) and was admitted for ACE induced angioedema. In addition to her lip swelling the patient described numbness and tingling in her left upper extremity. There was concern that this patient may be having a stroke, therefore an MRI with gadolinium was ordered. Within minutes of receiving a gadolinium compound, Gadopentate diglumine (Magnevist), the patient began having generalized pruritus which progressed to difficulty swallowing, shortness of breath and unresponsiveness. Advanced life support (ACLS) was initiated and the patient recovered without any further complications.
The patient had an elevated tyrptase level at 66 ng/ml (ref: 2-10 ng/ml) which was drawn immediately after the reaction. Tryptase levels drawn at base line was 6 ng/ml. Serum complement C4 level, C1Q, and C1 esterase inhibitor was all within normal limits. ImmunoCap for latex was also negative. In addition the patient reports having received aspirin in the emergency room and an aspirin challenge performed on follow-up visit was negative. The patient was instructed to avoid all radiocontrast media and her ACE inhibitor was changed to a calcium channel blocker. She was asymptomatic during several follow-up visits.
Reactions to gadolinium are rare with the overall incidence of allergic reactions is 0.004-0.7%. The incidence of severe a severe anaphylactoid reactions are thought to be even less common with reactions ranging from is 0.001-0.02%. The highest risks are patients with previous reactions to gadolinium contrast and possibly patients with previous reactions to iodinated radiocontrast media. We report a rare case of anaphylaxis due to gadolinium.