Eczematous skin reaction associated with intravenous immunoglobulin infusion: A case report and review of the literature

Abstract

Intravenous immunoglobulin (IVIg) therapy has been increasingly used to treat haematologic, neurologic, autoimmune, immunodeficiency, and dermatologic disorders. Cutaneous adverse reactions to IVIg are rare and include urticaria, maculopapular rash, lichenoid eruption, and alopecia. We report a case of a very rare eczematous skin reaction associated with IVIg infusion and review the existing literature. A 65-year-old woman developed an extensive eczematous reaction that occurred approximately seven days after her second monthly infusion of IVIg for Waldenstrom's macroglobulinaemia. The onset was characterised by dyshidrotic lesions on the palms and dorsal surfaces of the hands, followed by a more generalised eczematous eruption affecting the upper and lower limbs, chest, and scalp. Histologic analysis of a biopsy specimen from the arm revealed features consistent with spongiotic eczematous dermatitis. The skin lesions resolved after treatment with topical corticosteroids, and no new lesions developed after stopping IVIg infusions. Eczematous skin reactions associated with IVIg are very rare. As highlighted in our case, the rash characteristically starts as dyshidrotic eczema that is initially localised to the palms but may be followed by a more generalised eczematous eruption that extends to the rest of the body. The aetiopathogenesis remains unknown. The reaction often resolves within a period of 1-4 weeks from onset but can reappear more rapidly and extensively following readministration of IVIg, suggesting the existence of immunologic memory, and supporting the diagnosis of an adverse allergic drug reaction. The use of topical or systemic corticosteroids is recommended to control symptoms. This rare cutaneous adverse reaction that occurs as a consequence of IVIg infusion, including its characteristic distribution at onset and clinical course, should be recognised by dermatologists. Furthermore, IVIg-induced eczematous skin reaction is not a contraindication to further treatment if clinically indicated. In some cases, eczematous reactions have resolved despite continued IVIg treatment.L6381498762022-06-08 <br />