Pompholyx induced by intravenous immunoglobulin therapy.

Abstract

Intravenous immunoglobulin (IVIg) therapy is increasingly used to treat a variety of immune mediated disorders [1], including several neurological conditions [2]. It is relatively safe and often effective for patients unresponsive to other therapies. Adverse reactions are usually minor and are said to affect no more than 10% of patients [3]. Various skin reactions (urticaria, leukocytoclastic vasculitis, baboon syndrome, erythema multiforme, petechiae, alopecia, fl ushing, palmar pruritus, hyperhidrosis, eczematous dermatitis, and dyshidrotic eczema or pompholyx) have been described [4-8]. A 40-year-old woman diagnosed with autoimmune cerebellar disease was treated with a 5-day course of IVIg therapy (Flebogamma 5%, Instituto Grifols SA, Parets del Valles, Spain) at the standard dose of 0.4 g/kg/d. On the last day of the fi rst cycle of 5 days, an acute reaction involving pruritic erythematous papules and vesicles appeared on her palms. No other drugs were taken before or during treatment. The lesions persisted for more than 2 weeks. Before the next cycle 6 months later, a course of antihistamines (dexchlorpheniramine) was added to the treatment in order to prevent the lesions, but a similar reaction occurred, this time also affecting the right side of the face and with mild general symptoms (malaise and febrile sensation). Topical steroids were prescribed and the lesions subsided again after 2 weeks. The patient was then referred for further evaluation. The patient had a history of an eczematous reaction on her hands after the use of perfumed soap several years before the consultation but reported no other skin or allergic conditions. Patch tests with the Spanish standard battery of the Spanish Contact Dermatitis Investigative Group (GEIDC), immunoglobulin (Flebogamma 5%, Instituto Grifols SA, Parets del Valles, Spain) (on back and palms) and with artifi cial leather “as is”. Prick and intradermal tests were performed with immunoglobulin (1/100, 1/10 in phosphate buffered saline and “as is”). Artifi cial leather was tested because of a topographic correlation between the lesions (palms and right side of the face)