LETTER
Meningitis and Skin Reaction after Intravenous Immune Globulin Therapy
Benoit Catteau;
Emmanuel Delaporte; and
Frederic Piette
15 December 1997 | Volume 127 Issue 12 | Page 1130
TO THE EDITOR:
We read with interest the article by Dalakas on IVIg therapy in neurologic diseases, especially the section on skin reactions [1]. We observed a cutaneous reaction to IVIg, clinically typical of pompholyx, in two male patients. These patients were 34 and 61 years of age and were treated for the Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy, respectively, with IVIg (0.4 g/kg of body weight over 5 days).
One patient developed nonpruritic palmoplantar vesicular lesions 5 days after the start of therapy. The other had slightly pruritic erythema and vesicles on the lateral aspects of the fingers and palms 2 days after the end of the first course of IVIg. The eruption recurred during the eight following courses of IVIg within 48 hours but became more and more discrete. Neither patient had hyperhydrosis, flushing, or systemic symptoms during the infusions. The eruption subsided within a few days with desquamation. The results of patch tests and prick tests with IVIg were negative.
Skin reactions to IVIg are rare and include urticaria, palmar pruritus, petechia, alopecia, leukocytoclastic vasculitis, hyperhydrosis, and flushing [1, 2]. Generalized eczematous eruptions have been reported; one occurred 3 weeks after a second infusion of IVIg [3], and one was attributed to thimerosal [4]. The pathogenesis of pompholyx is unclear, although ingested or direct-contact antigens may have a role. The implication of sweat glands has been debated, and some authors consider that the high perspiration rate of the palms and soles favors a high concentration of allergens [5]. It can be postulated that high quantities of IVIg in the palmoplantar areas may induce immunologic reactions responsible for pompholyx, especially in patients with neurologic diseases.
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Author and Article Information
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University Hospital Center Lille; 59037 Lille Cedex, France
1. Dalakas MC. Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med. 1997; 126:721-30.
2. Zurcher K, Krebs A. Cutaneous Drug Reactions: An Integral Synopsis of Today's Systemic Drugs, with Drug Tables and Sign/Symptom Tables. 2d ed. Basel: Karger; 1992:246-7.
3. Barucha C, McMillan JC. Eczema after intravenous infusion of immunoglobulin. Br Med J. 1987; 295:1141.
4. Mackenzie D, Vlahcevic ZR. Adverse reaction to gammaglobulin due to hypersensitivity to thiomersal. N Engl J Med. 1979; 290:749.
5. Crosti C, Lodi A. Pompholyx: a still unresolved kind of eczema. Dermatology. 1993; 186:241-2.
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