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

[Richard Wasserman]

You should report this in a letter or brief report. I have not heard it
before. I would change to daily IGSC push 1-2g/day to achieve the desired
monthly dose.

Richard Wasserman
Dallas


On Thu, Jan 17, 2013 at 3:23 PM, Javier Chinen <chinej20 at hotmail.com> wrote:


>

> 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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-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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