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Generalized Bullous Fixed Drug Eruption to Iodinated Contrast Media in Skin of Color

      A 69-year-old Malay woman presented with a widespread painful blistering rash, which had first begun over her neck and trunk, a few hours after a computed tomography scan performed with 90 mL of iohexol contrast for surveillance of sigmoid adenocarcinoma. Examination was notable for multiple circular hyperpigmented patches with inlying blisters and well-demarcated erosions involving her upper lip, neck, abdomen, and lower extremities (Figure 1, Figure 2). The total area of detachable epidermis was approximately 25%. Despite extensive cutaneous involvement, she was otherwise systemically well and clinical parameters were within normal limits. Further probing elicited a history of similar eruptions in the past, localized to a few spots on her thighs which were also involved this time. Strikingly, each of these episodes occurred within 24 hours following iodinated contrast media administration and was self-limiting in nature.
      Figure 1:
      Figure 1Multiple well-demarcated erosions over the chest and abdomen, with flaccid bullae over the right forearm, pubic area and right thigh.
      Figure 2:
      Figure 2Circular erosions over the thighs with surrounding denuded epidermis.

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