Asthma and vasculitis. Response to intravenous immunoglobulins

A 17-year old woman suffered progressively worse asthma attacks with hypereosinophilia, patchy lung infiltrates, and acute ischemic lesions of the fingers and purpuric lesions suggesting vasculitis. She developed hypoxemic respiratory failure despite treatment with high-dose corticosteroids. Intravenous cyclophosphamide was introduced with good clinical response, but had to be discontinued because of intolerance. Intravenous immunoglobulins were given in monthly doses for 10 months while the corticosteroid dose was tapered off. This treatment was associated with rapid clinical and biochemical improvement without adverse effects. We conclude that intravenous immunoglobulins is a useful complementary treatment for patients with severe asthma associated with pulmonary vasculitis refractory to corticosteroid therapy alone.