[CIS PIDD] [cis-pidd] Subcutaneous Plaques following immunoglobbulin infusions

[Richard Wasserman]

There is little if anything published about infusion site reactions in IGSC
in the US since the SC specific products were introduced in the US. Dr.
Heimall's patient is clearly different and should be reported but, given
the number of people on this list serve, might we be able to report some
useful information about IRS persistence and subq nodules?
Richard Wasserman


On Fri, Jun 14, 2013 at 9:08 AM, Kobrynski, Lisa <lkobryn at emory.edu> wrote:


>  We have had three patients develop ulcerative lesions which become

> indurated but not painful and have occurred sporadically. I agree that one

> concern I had was that the infusion was given intradermally. But I would

> expect that to be painful.

> I also have several patients develop nonpainful SC nodules (3-5mm) after

> infusion with the 20% product which resolve after a few weeks. I have not

> had anyone complain of this with the 10% product.

> You might consider doing a biopsy of the lesion to see what kind or tissue

> reaction is occurring.

> Lisa Kobrynski

>

> Sent from my iPhone

>

> On Jun 13, 2013, at 4:56 PM, "Richard Wasserman" <

> drrichwasserman at gmail.com> wrote:

>

>   I take care of a teenage ADA deficiency SCID patient who developed

> subcutaneous nodules, indurated 2cm masses without overlying discoloration,

> when he began treatment with the 20% product. They have been slow to

> resolve. He is tolerating the low infusion site reaction 10% product

> without problems.

>

>  Are you confident that these infusion were subcutaneous and not

> intradermal?

> Richard Wasserman

>

>

> On Wed, Jun 12, 2013 at 9:33 PM, Heimall, Jennifer <

> heimallj at email.chop.edu> wrote:

>

>>  I have an 18y/o patient with specific antibody deficiency who was

>> treated with subcutaneous immunoglobulin replacement.  After about 10

>> months, she developed painful nodules on the left flank.  We encouraged

>> rotation of infusion sites and tried a change of product.

>>

>> Despite these changes and having been off of subcutaneous immunoglobulin

>> for the last 2 months, she now has large (11cmx6cm), tender, firm plaques

>> with overlying hyperpigmentation present on both sides of her lower

>> abdomen.

>>

>> Has anyone else encountered this with patients on subcutaneous

>> immunoglobulin?

>>

>>

>>

>>

>>

>>

>> Jennifer Heimall, MD

>> The Children's Hospital of Philadelphia

>> Allergy/Immunology

>> 3550 Market Street

>> 3rd Floor

>> Philadelphia, PA 19104

>> phone: (267)426-9231

>>

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>

>

>

>  --

> Richard L. Wasserman, MD, PhD

> DallasAllergyImmunology

> 7777 Forest Lane, Suite B-332

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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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