Use of intravenous immunoglobulin in the treatment of severe cutaneous drug reactions in patients with AIDS

Patients with AIDS have increased frequency of severe cutaneous reactions to certain medications, and these patients often require prolonged hospitalizations because of these reactions. Some reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, appear to involve immune-mediated destruction of cutaneous tissue and therefore respond to antiinflammatory agents. Intravenous immunoglobulin has potent antiinflammatory activity. We have treated two patients with AIDS and severe drug reactions with intravenous immunoglobulin with good outcome. Corticosteroids were avoided because of the potential risk of further immunosuppression in these already immunodeficient patients. Both patients improved rapidly with intravenous immunoglobulin, and hospitalizations for treatment of these reactions were either prevented or shortened because of this treatment. Intravenous immunoglobulin therefore appeals to be an effective alternative treatment for severe cutaneous drug reactions in immunodeficient patients.