[CIS PIDD] [cis-pidd] Rash with IVIG and SCIG

[Miriam Hurst (ADHB)]

Hi all,

I was wondering if anyone had any experience of managing a patient with an eczematous reaction initially to SCIG, now recurring with IVIG. He is a 39 year old male with CVID and bronchiectasis, on IVIG 33g monthly but had significant problems with headache for 12-24 hours post infusion despite premed. He was on this for about 6 years despite these symptoms (at a peripheral hospital) and then earlier this year after review was switched to SCIG. Some days after the first dose he began developing a rash initially around the injection sites but spreading to involve his entire body, esp palms/soles of feet - photo attached.

Skin biopsy was reported as consistent with subacute spongiotic eczema but with extravasated red cells and interface activity supporting possible drug reaction. He was taken off his SCIG and treated with prednisone, with complete resolution of his rash. After reviewing the literature we trialled an alternative IVIG product with premed (including 10mg prednisone), but the rash recurred 2 days later.

He is also significantly lymphopenic (0.45 x 10^9/L) with CD4 130, which seems to have happened over the same time period as the rash but preceding the prednisone use.

We do have an alternative SCIG product available but I am concerned the rash will recur with this as well. Does anyone have any advice on possible management approaches?

Thanks very much,

Miriam


Miriam Hurst, MBChB, FRACP, FRCPA
Clinical Immunologist/Immunopathologist

Clinical Immunology
Auckland Hospital
Auckland
New Zealand

phone: +64 9 307 4949
fax:      +64 9 3074940
email: mhurst at adhb.govt.nz<mailto:mhurst at adhb.govt.nz>


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