RESUMO
Immediate or delayed hypersensitivity reactions to iodinated contrast media (ICM) occur in 0.5-3 % of patients receiving radiological examinations using the last generation ICM. Although the majority of the reactions are mild to moderate, severe and potentially lethal reactions may occasionally be observed. In the last few years, there has been an increase of patients referred to the dermato-allergology department for the work-up of a hypersensitivity reaction to ICM. In this article, the allergological investigations and their indications are described in the case of a suspicion of ICM hypersensitivity.
Les réactions d'hypersensibilités immédiates ou retardées aux produits de contraste iodés (PCI) surviennent chez 0,5-3 % des patients bénéficiant d'un examen d'imagerie radiologique utilisant les PCI de dernière génération. Bien que la plupart des réactions soient d'intensité faible à modérée, des réactions sévères, parfois mortelles, sont possibles. Depuis quelques années, on note une nette augmentation du nombre de patients adressés en consultation de dermato-allergologie pour mise au point de réaction d'hypersensibilité aux PCI. Dans cet article, l'exploration allergologique devant une suspicion d'hypersensibilité aux PCI est décrite avec ses indications.
Assuntos
Meios de Contraste , Hipersensibilidade , Humanos , Meios de Contraste/efeitos adversos , Hipersensibilidade/etiologiaRESUMO
Basal cell carcinoma of the umbilicus is very rare. The nodular subtype is the main representative. Giant basal cell carcinomas represent around 1% of all basal cell carcinomas. The hedgehog pathway inhibitor vismodegib is indicated for advanced basal cell carcinoma and CD56-negative immunostaining seems indicative for successful treatment. A 54-year-old man presented a 10 cm × 14 cm large and 4.5 cm deep morphea-form basal cell carcinoma with faint immunohistochemical CD56 expression arising from the umbilicus. A sequential treatment was initiated with debulking using vismodegib 150 mg per day for 4 months, followed by reconstructive surgery. To the best of our knowledge, this is the first report of a giant basal cell carcinoma of the morphea-form type of the umbilicus. The sequential treatment plan reduces the duration of vismodegib inherent adverse effects and significantly reduces the tumor mass prior to surgery. Besides increasing adherence to vismodegib treatment, this approach facilitates the surgical technique and improves cosmetic outcome.
