Keywords Ataxia · Contrast medium · Intravenous pyelography

Sirs,

Delayed rea ctions to contrast media, which by definitiondevelop more than 1 h after administration of contrastmedia, have been reported to occur in 0.5%–2% of recip-ients [1]. Although most delayed reactions to contrastmedia are transient and self-limiting, severe life-threat-ening reactions have been reported [2, 3]. The T-cell-me-diated response to contrast media is thought to be an im-portant factor in the development of these reactions [1].Rash, itching, and headache are the most frequent mani-festations of this condition [4, 5]. While many othersigns and symptoms in the respiratory, cardiovascular, orgastrointestinal systems are listed amongst delayed reac-tions to contrast media [1, 4, 5], ataxia has never beenreported.

A previously healthy, 4-year-old girl was admitted toour hospital because of acute pyelonephritis. She had nohistory of administration of contrast media or allergicdiseases. Intravenous administration of cefotiam hydro-chloride improved her condition and laboratory data rap-idly. The patient was discharged on the 7th day follow-ing admission. Renal ultrasonography showed mild dila-tation of the left renal pelvis without dilatation of theureter. Two weeks later she underwent intravenous pyel-ography, using 20 ml (300 mg/ml) of iopamidol, a non-ionic contrast material. Twenty hours later she sufferedfrom ataxic gait and dizziness, and was admitted to thehospital. Body temperature was 36.6°C, blood pressure

was 114/70 mmHg, and heart rate was 86/min. She hadtruncal ataxia and dizziness. Nystagmus or tinnitus wasnot found. Romberg’s sign was negative. Laboratorystudies, including complete blood cell counts, liver en-zymes, electrolytes, and C-reactive protein, were withinnormal ranges. Brain computed tomography and electro-encephalography revealed no abnormal findings. Oneday after admission she developed an erythematous maculopapular rash on her arms, legs, and trunk. Ataxia,dizziness, and rash subsided spontaneously 2 days afterthe development of this rash, and she was discharged ingood condition.

While the precise pathogenic mechanism for the de-velopment of ataxia in our patient is unclear, the pa-tient’s ataxia is likely to be a delayed reaction to contrastmedia because no other factors causing ataxia werefound. It appears necessary to add ataxia to the list of delayed reactions to contrast media.

References

1. Christiansen C, Pichler WJ, Skotland T (2000) Delayed allergy-like reactions to X-ray contrast media: mechanistic consider-ations. Eur Radiol 10:1965–1975

2. Savader SJ, Brodkin J, Osterman FA (1995) Delayed life-threatening reaction to non-ionic contrast media. J Interv Radiol10:115–116

3. Newman B (2001) Delayed adverse reaction to nonionic con-trast agents. Pediatr Radiol 31:597–599

4. Yoshikawa H (1992) Late adverse reactions to nonionic contrastmedia. Radiology 183:737–740

5. Yasuda R, Munechika H (1998) Delayed adverse reactions tononionic monomeric contrast-enhanced media. Invest Radiol33:1–5

T. Watanabe (✉)Department of Pediatrics, Niigata City General Hospital, 2-6-1 Shichikuyama, Niigata 950-8739 Japane-mail: twata@hosp.niigata.niigata.jpTel.: +81-25-2415151, Fax: +81-25-2483507

Pediatr Nephrol (2003) 18:303DOI 10.1007/s00467-002-1048-2

L E T T E R T O T H E E D I T O R S

Toru Watanabe

Ataxia as a delayed reaction to contrast medium for an intravenous pyelography

Published online: 11 January 2003© IPNA 2003