Intravenous fluorescein overdose in a child undergoing fluorescein angiography

Fluorescein angiography is a fluorescent dye-based imaging procedure, most commonly indicated in the pediatric setting to evaluate peripheral retinal vascular lesions. Fluorescein dye is organic, water soluble, and largely excreted renally, with a reassuring safety profile at therapeutic doses. While toxicity with intrathecal overdose has been reported, the effect of intravenous exposure to supratherapeutic levels has not been previously documented in the literature. We report the case of a 10-month-old girl with incontinentia pigmenti who received more than four times the recommended dosage of fluorescein during scheduled fluorescein angiography and developed marked yellowing of skin, sclera, stool, and urine. She was seen by the toxicology team and underwent monitoring for 8 hours before being discharged, with no adverse consequences detected during follow-up.