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 as a clinical manifestation suggesting increased serum IgG levels in a patient with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms

“…According to previous reports, pompholyx typically occurred 5–7 days after initiating IVIg in patients with chronic inflammatory demyelinating polyneuropathy, Guillain–Barré syndrome, Stevens–Johnson syndrome, idiopathic thrombocytopenic purpura and Kawasaki disease: a time frame quite similar to that seen in our patient. The range of increase in the serum IgG levels after the nadir in our case (12·8 mg kg −1 body weight) was equivalent to that (9·9–65·6 mg kg −1 ) achieved in the serum of patients treated with high doses of IVIg who were diagnosed with Stevens–Johnson syndrome or pemphigus vulgaris and treated in our dermatology department from 2008 to 2014.…”

The Safety Profile of Home Infusion of Intravenous Immunoglobulin in Patients With Neuroimmunologic Disorders

“…15,21 Generalized skin reactions were observed in 1.9% of patients in our series. 23,[49][50][51][52][53][54] Aseptic meningitis was observed in 0.2% of patients in our study and was reported in other studies with a mean incidence of 6.7%. Skin reactions have been reported in 6%-14% of patients in other series.…”

Intravenous immunoglobulin-induced eczematous dermatitis treated with dupilumab

“…IVIG-induced eczema is commonly treated with topical steroids; however, severe cases often require oral steroids and lead to IVIG discontinuation. 1 , 3 , 5 , 6 Our report shows that dupilumab is effective in treating widespread IVIG-induced eczema that was refractory to other therapies, allowing IVIG treatment to be continued without the risks associated with frequent high-dose systemic corticosteroids.…”