• Xiuxiu Ma, Chaozhu He, Xiaohong Zeng, Xiaohua He, and Yanfang Bi.
• School of Nursing, Nanchang University, First Clinical Medical College, Jiangxi Medical College, Nanchang University, Jiangxi, China.
• Medicine (Baltimore). 2025 Jan 31; 104 (5): e41301e41301.

RationaleAcute generalized exanthematous pustulosis (AGEP) is a rare delayed allergic reaction, which is mostly caused by drugs, but there are few reports of iodixanol in particular. At present, 4 cases induced by iodixanol have been reported in the literature, but none have been reported in China.Patient ConcernsIn this report, we report a case of AGEP induced by intravenous bolus infusion of iodixanol during multislice spiral CT enhanced scanning of the whole abdomen in a patient with rectal malignancy. A 35-year-old female patient presented with a larger rash/erythema on the head and neck and felt itchy.DiagnosesA large erythema/rash and white, sterile pustules based on erythema spread from head, neck to the whole body in a short period of time. Blood cell results showed high levels of white blood cell, neutrophils, C-reactive protein and interleukin-10, and decreased levels of some immune indicators. Pathological biopsy results showed that there was immune cell infiltration around the superficial dermis.InterventionsImmediate avoidance of potential allergens and treatment with steroids, antihistamines and other medications, followed by adjustment with cyclosporine and human immunoglobulin.OutcomesAt 1 year's follow-up, the patient did not develop any symptoms of discomfort and increased awareness of allergen prevention.LessonsThe reported case is an extremely rare and severe AGEP, typically characterized by pruritus, edema, large erythema/rash, dense white needle-like sterile pustules based on erythema/rash, and desquamation. After discontinuation of exposure to iodixanol, the patient received symptomatic supportive treatment, mainly drug response. She eventually recovered without recurrence. In the future, with the in-depth exploration of more studies, the use of Iodine Contrast Media will be more standardized and scientific.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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