Intravenous immunoglobulin-induced lichenoid dermatitis: a unique adverse reaction

Intravenous immunoglobulin (IVIG) therapy has been used to treat various diseases. Generalized allergic reactions (types I, II, and III) to IVIG are uncommon and are usually related to the rate of infusion. Cutaneous reactions have been anecdotally described. Herein we describe a 73-year-old man with Sjögren's syndrome who had development of a lichenoid cutaneous eruption after administration of IVIG therapy. CD3 immunostaining demonstrated the overwhelming presence of T lymphocytes within a lesional skin biopsy specimen, and thus we present an alternative cell-mediated immune mechanism (type IV) by which allergic reactions to IVIG may occur.