Fatal Anaphylaxis to Contrast a Reality: A Case Report

We are describing the case of a 45-year-old female with a past medical history of severe chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, and anxiety and with no known allergies to contrast media. The patient presented to her primary care doctor’s office with typical symptoms of COPD exacerbation. She was given a five-day course of prednisone (40 mg/day) and Azithromycin and advised to follow up with her pulmonologist. The patient called her pulmonologist’s office five days later due to non-relief of symptoms and was advised to get a chest radiograph. The chest X-ray did not show evidence of any acute changes. Her symptoms continued to worsen, and she was advised to get a computerized tomography (CT) of the chest with pulmonary embolism (PE) protocol, where 60 ml of Isovue-370 (Iopamidol - a non-ionic radiocontrast dye) was injected per the PE protocol. She had an unpredictable fatal anaphylactic reaction to non-ionic contrast dyes and suffered a cardiac arrest while getting the scan done.