Deep Venous Thrombosis After High-Dose Intravenous Immunoglobulin in the Treatment of Pemphigus Vulgaris
A 43-year-old black man with pemphigus vulgaris was started on intravenous immunoglobulin (IVIg) therapy after his disease was found to be refractory to prednisone alone and prednisone in combination with mycophenolate mofetil, azathioprine, methotrexate, cyclosporine, and oral cyclophosphamide. The patient subsequently developed a deep venous thrombosis (DVT) that was attributed to the IVIg. IVIg has been associated with numerous thrombotic complications such as pulmonary embolism and myocardial infarction. Traditional risk factors for thrombotic complications, such as hypertension, a history of coronary artery disease, and immobility, should be considered as relative contraindications to IVIg therapy.
We report the fourth case of thrombotic complications occurring with IVIg in the treatment of dermatologic diseases, and we maintain that caution should be exercised in employing this treatment modality in patients who have underlying risk factors for thrombotic events. In particular, caution should be used with immobile patients and with those who need to undergo surgery or other procedures that may render them susceptible to DVT. We reported this case to the US Food and Drug Administration Adverse Event Reporting System, and we encourage others to do the same if thrombotic complications with IVIg are encountered.
