Intravenous immunoglobulin as a therapy for severe or steroid-recalcitrant erythema multiforme major: a case series

Erythema multiforme (EM) is typically self-limiting. However, severe EM major may cause significant morbidity and lacks evidence-based therapeutic guidelines. Intravenous immunoglobulin (IVIg) has primarily been used in recurrent EM. This study evaluates IVIg use in severe first-episode or steroid-recalcitrant EM major. A retrospective analysis reviewed six patients with EM major treated with IVIg at a tertiary Australian hospital. IVIg was administered in eight instances. Disease triggers included Mycoplasma pneumoniae in three admissions, unknown aetiology in three admissions, rhinovirus/influenza A in one admission and SARS-CoV-2 virus in one admission. Two patients developed recurrent EM. All patients received systemic corticosteroids. All patients received IVIg within 4 days of admission, demonstrating complete response to therapy with a mean improvement time of 4.75 days. IVIg was well tolerated and demonstrated efficacy in severe or corticosteroid-refractory EM major. Further studies are required to validate its efficacy.