[CIS PIDD] [cis-pidd] prolonged neuropathic pain after IVIG and SCIG

[Javier Chinen]

Dear all,  I am being consulted about a 30 yo woman who has had a solid diagnosis of CVID for 15 years and has received monthly IVIG. She developed severe pain after her last IVIG infusion, first on her right calf, progressing to her right arm within a day, and generalized to her left extremities in the next day. She also had a headache. The pain took about two weeks to progressively resolve. It was decided to switch to SCIG (12g). She developed same pain. No headaches this time. The difference with IVIg was that that the pain started in the second day rather than immediately, and had the same progression. After this second episode of pain resolved, she tried a smaller dose (4g), same pain, though of less severity.She has had headaches associated to IVIG, but not this pain. About 12 months ago, she had similar though very mild pain while she was pregnant (7 months) for the first time, however, she had IVIG infusions afterwards without the pain. There is no fever, no other signs of inflammation, it causes muscle weakness, but is not totally incapacitating. It resolves in the same order of sites it appears. Gets better with prednisone and NSAIDs. Neurology evaluation, including brain MRI during pain and headache episode was inconclusive.Her levels were kept at 900-1000 with 0.5g/Kg IVIG every 3 wks  I would appreciate any report of similar cases and how they were managed. Best regards,  Javier   		 	   		  
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