Severe Eczematous Skin Reaction After High-Dose Intravenous Immunoglobulin Infusion

Abstract

Background: High-dose intravenous immunoglobulins (IVIGs) are increasingly used to treat inflammatory and/or autoimmune disorders. In dermatology, they provide therapeutic benefit in Kawasaki disease and certain cases of dermatomyositis. While most adverse effects following IVIG treatment are not severe, occasionally more severe adverse effects occur, including anaphylactic reactions and acute, usually transient, renal failure. Observations:We report 4 cases of a characteristic severe extensive eczematous reaction that occurred approximately 10 days after IVIG infusion for polyradiculoneuritis. In all cases, onset was characterized by dyshidrotic lesions on the palms, rapidly followed by pruriginous maculopapular lesions involving the whole body. All patients were treated with topical and/or systemic ste-roids, and complete resolution of skin lesions was observed within 1 month. To date, 33 cases of cutaneous rash following IVIG infusion have been reported in the literature, mostly in neurology journals, and the features are identical to those reported herein.Conclusions: Severe eczematous skin reaction with a characteristic initial localization to the palms and/or soles that then extends to the rest of the body is a rare but characteristic adverse effect of high-dose IVIG therapy. Although the precise mechanism of this cutaneous eruption remains to be elucidated, its occurrence within days of IVIG infusion, its characteristic distribution at onset, and its clinical course should be recognized by dermatologists.

Pompholyx of the Hands after Intravenous Immunoglobulin Therapy for Clinically Isolated Syndrome: A Paediatric Case

“…In fact, Vecchietti et al (2) assessed that neurologic disorders, frequently associated with immunological alterations or viral infections, may predispose the occurrence of pompholyx related to IVIG therapy. The authors noticed that most of the cases of IVIGrelated pompholyx reported in the literature occurred among patients who had received IVIG for neurologic affections (31/37 cases described in this review), although considering the bias of more frequent use of IVIG therapy by neurologists (2). Inaddition, it should be pointed out that IVIGs for neurological diseases are generally administrated at higher doses than those used for immunodeficiency disorders (6).…”

Dermatolojik hastalıkların tedavisinde immunmodülasyon

“…Yorgunluk, ateş ya da mide bulantısı gibi şikayetler infüzyon sonrasında da gelişebilmekte ve 24 saate kadar devam edebilmektedir. Deri lezyonları ekzematöz döküntüler, ürtiker, likenoid reaksiyonlar, kaşıntı ve peteşi şeklinde bildirilmiştir 44,45 . Daha nadir görülen ama daha şiddetli yan etkiler tromboembolik olaylar, hemolitik anemi, akut akciğer hasarı, aseptik menenjit, anafilaksi ve renal tubuler nekroz şeklindedir 30,46 .…”

Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease

“…Although case-report studies reported that KD patients with atypical skin rash might be associated with CALs and IVIG treatment 7,8) , the correlation between skin rash characteristics and CALs is still unclear.…”