Cryoglobulinaemic vasculitis caused by intravenous immunoglobulin treatment

Extract

Introduction

Intravenous immunoglobulin (IVIG) is used as replacement treatment for patients with hypogammaglobulinaemic states (both primary and secondary), and due to its immunomodulatory properties is also used to treat certain autoimmune or inflammatory conditions (idiopathic thrombocytopenia purpura, Guillain–Barre syndrome, dermatomyositis, Kawasaki disease). Generally, administration of IVIG is safe, and although the incidence of reported side‐effects ranges from 5–15%, these are usually mild and comprise pyrexia, headache, malaise and rash [1,2]. More rarely, serious life‐threatening adverse reactions may occur including anaphylaxis (particularly in patients with IgA deficiency) [1] and acute renal failure [3]. Indeed, with respect to the latter, a recent editorial [4] has reviewed the available data regarding IVIG‐associated renal impairment and has suggested that in most cases the cause is non‐glomerular, but rather is secondary to proximal tubular ‘toxicity’.

In this report, we present a patient who developed cutaneous cryoglobulinaemic vasculitis, thrombocytopenia and presumed glomerulonephritis following IVIG therapy for treatment of Guillain–Barre syndrome (GBS).