Delayed cutaneous reaction — severe

Recognize

• Widespread or progressive rash post-contrast
• Generalized exanthematous pustulosis
• Findings resembling Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Cutaneous vasculitis
• Severe reaction in patient with SLE

Act — tap each step

1. 1Urgent dermatology and/or allergist consult
2. 2Systemic corticosteroids (e.g., Prednisone 40–60 mg PO daily taper)
3. 3Antihistamines for symptomatic relief
4. 4Monitor for systemic involvement (fever, mucosal erosions)
5. 5Document as severe delayed reaction — consider avoiding same agent class in future

Medications

Notes

• Rare fatalities have been reported with severe delayed reactions.
• Patients with SLE may be at increased risk for severe cutaneous reactions.
• Iodide mumps (salivary gland swelling) and acute polyarthropathy are rare delayed reactions, more frequent with renal dysfunction.