LAUSR

Skin hyperpigmentation from intramuscular or intravenous iron infusion is well documented. In most cases the pigmentation is localised to the site of the injection or cannula. We report here a case of widespread hyperpigmentation following an iron infusion. A 31-year-old female received a unit of packed red cells following a post-partum haemorrhage with a haemoglobin concentration of 61 g/l. During the transfusion she developed a widespread urticarial rash thought to be a transfusion reaction. No further transfusion was given. The next day the patient was given an intravenous iron polymaltose infusion. Soon after this her urticarial rash started to change colour. Subsequently, the rash settled; however, there was brown discolouration in the same distribution as the rash consistent with iron deposition. The patient has attended multiple appointments for laser therapy with a dermatologist, which improved the staining. However, 2 years later, she still has residual staining in her lower limbs, presumed to be permanent and with significant psychological impact. Skin hyperpigmentation is a potential adverse effect of intravenous iron infusion, which is often forgotten. Skin staining can last from 6 months to 2 years or even longer. Even though usually localized to the area of extravasation, in this patient the skin hyperpigmentation is widespread, presumably due to increased vascular permeability associated with the urticarial rash. It is known that iron deposition can occur at sites of inflammation following iron infusions and subsequently our centre has added widespread skin rashes to the list of relative contraindications for iron infusion.