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

[Risma, Kimberly]

I have recently encountered the same issue in a 13 yo boy with CVID.
He developed a granulomatous skin rash (biopsy proven) on his arms
at about the same time that the SC infusion sites became hardened. They have
not resolved and are not discolored, not ulcerated, not painful.
Kim
Kimberly Risma MD PhD
Assistant Professor
Allergy/Immunology
Cincinnati Children's Hospital Medical Center


From: Richard Wasserman [mailto:drrichwasserman at gmail.com]
Sent: Friday, June 14, 2013 10:14 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Subcutaneous Plaques following immunoglobbulin infusions

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<mailto: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<mailto: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<mailto: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<tel:%28267%29426-9231>

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DallasAllergyImmunology
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