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Prophylactic IVIG and corticosteroids for severe skin reactions post radio-contrast.

### Learning Points for Clinicians

Delayed skin reactions to radio contrast media (RCM) arise 1 h to 1 week after RCM administration. We describe the first report of successful prophylactic use of low-dose intravenous immunoglobulin (IVIG) in preventing severe late onset skin reaction to RCM despite conventional prophylaxis.

An 81-year-old Caucasian male presented with acute coronary syndrome, requiring high-dose radio contrast media (RCM) life-saving catheterization. He had a history of diffuse maculo-papular rash 24 hr after an RCM procedure. The patient had a total of four RCM procedures at outside facility with the use of ionic, hyper osmolar, iodinated RCM and non-ionic, non-iodinated low-osmolar contrast. Despite pretreatment with a conventional prophylactic regimen of antihistamine and corticosteroid medications1 and use of non-iodinated low-osmolar RCM, he developed a delayed skin rash …