[PAGID] SQ gammaglobulin reaction

[Rathkopf Melinda M Maj 759 MDOS/MMIA]

We are not using SQ Ig here, but one of our neurologist who is using IVIG
sent us this case:

"Have you heard of any dermatologic skin reactions to IVIG?  I have a
gentleman that developed a mild skin rash on his palms following his first
IVIG course (for neuropathy) at BAMC in March.  The rash persisted, but
never got any worse.  In May, he got a 2nd IVIG course, and the rash surged.
Its a distal, exfoliative rash involving his palms, and recently became
noticable on the soles of his feet.  BAMC dermatologists apparently thought
this was a "delayed IVIG reaction", and their allergists agreed (albeit
reluctantly).  

He's now >6wks out from his last IVIG use, and the rash is still there (if
not worse).  Ever heard of this before?  I'm going to send him to our
dermatologists for a 2nd opinion, but I thought I'd ask your advice also.
Thanks for your help!"


Any comments or suggestions?

Thanks,

Melinda M. Rathkopf, MD
Wilford Hall Medical Center


-----Original Message-----
From: pagid-bounces at clinimmsoc.org [mailto:pagid-bounces at clinimmsoc.org] On
Behalf Of Christine Seroogy
Sent: Friday, June 24, 2005 8:09 AM
To: pagid at clinimmsoc.org
Subject: [PAGID] SQ gammaglobulin reaction

Colleagues,

A 5y/o male patient of ours has been on sq gammaglobulin (16% Baygam) 
for about one year without difficulty.  During his last infusion, 
within 30 minutes he developed a disseminated papular rash.  He was 
seen in his local ED and given benadryl.  There were no other signs or 
symptoms.  Over the next day, the rash covered 100% of his body (palms 
and soles) and has slowly been regressing.  One week later, the papular 
rash covers 5% of his body but he has developed large (10cm) 
desquamating coalescent lesion on his buttock and smaller lesions 
around is mouth (by report he did have some sores in his mouth 
transiently, no eye involvement).  Has anyone seen this?  It is hard 
for me to dismiss the temporal relationship between rash and infusion.  
Thank you for any comments, Chris


Chris Seroogy, M.D.
Assistant Professor
Dept. of Pediatrics
Mail:  H4/474 CSC, Mailstop 4108
Shipping:  H4/431 CSC, Mailstop 4108
600 Highland Ave.
Madison, WI  53792
phone: 608- 263-2652
fax: 608-265-0164

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