Hatake Seira, Shimizu Fumitaka, Honda Masaya, Takahashi Shiori, Koga Michiaki, Kimura Kazumi, Kanda Takashi
Department of Clinical Neuroscience and Neurology, Yamaguchi University Graduate School of Medicine.
Department of Neurology, Graduate School of Medicine, Nippon Medical School.
Rinsho Shinkeigaku. 2022 Apr 27;62(4):267-271. doi: 10.5692/clinicalneurol.cn-001681. Epub 2022 Mar 29.
Intravenous immunoglobulin (IVIg) have been administrated for the long time in patients with several autoimmune neuromuscular diseases. Eczematous eruption has been described as IVIg-induced adverse effect.
The purpose of this study is to clarify the incidence and characteristic of IVIg-induced eczematous eruption in autoimmune neuromuscular disease.
We retrospectively collected the data from 92 patients with autoimmune neuromuscular diseases, including 35 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), 8 patients with multifocal motor neuropathy (MMN), 25 patients with myositis, 15 patients with Guillain-Barré syndrome (GBS), and 9 patients with myasthenia gravis (MG), who have administrated IVIg in Yamaguchi University Hospital.
There are 10 patients (6 CIDP/4 MMN), who had an eczematous skin reaction after IVIg infusion. The frequencies of IVIg-induced eczematous eruption were significantly higher in patients with multifocal acquired demyelinating sensory and motor (MADSAM) and MMN than in patients with GBS, myositis, and MG. In addition, corticosteroids or immunosuppressive drugs had been administrated before IVIg treatment more frequently in patients with myositis and MG than in those with MADSAM and MMN.
MADSAM or MMN patients had more frequently IVIg-induced eczematous eruption than other autoimmune neuromuscular diseases. Pathophysiology of MADAM and MMN is considered to be cell-mediated immunity against the peripheral nerve and the accumulation of IgG in both epidermis and dermis of the hand after IVIg may induce the infiltration of inflammatory cells around the vessels in the skin, causing eczematous eruption in MADSAM and MMN.
静脉注射免疫球蛋白（IVIg）已长期用于多种自身免疫性神经肌肉疾病患者。湿疹样皮疹已被描述为IVIg引起的不良反应。
本研究旨在阐明自身免疫性神经肌肉疾病中IVIg诱导的湿疹样皮疹的发生率和特征。
我们回顾性收集了山口大学医院92例自身免疫性神经肌肉疾病患者的数据，其中包括35例慢性炎症性脱髓鞘性多发性神经病（CIDP）患者、8例多灶性运动神经病（MMN）患者、25例肌炎患者、15例吉兰-巴雷综合征（GBS）患者和9例重症肌无力（MG）患者，这些患者均接受了IVIg治疗。
有10例患者（6例CIDP/4例MMN）在输注IVIg后出现了湿疹样皮肤反应。多灶性获得性脱髓鞘感觉和运动神经病（MADSAM）和MMN患者中IVIg诱导的湿疹样皮疹发生率显著高于GBS、肌炎和MG患者。此外，与MADSAM和MMN患者相比，肌炎和MG患者在IVIg治疗前更频繁地使用皮质类固醇或免疫抑制药物。
MADSAM或MMN患者比其他自身免疫性神经肌肉疾病患者更频繁地出现IVIg诱导的湿疹样皮疹。MADAM和MMN的病理生理学被认为是针对周围神经的细胞介导免疫，IVIg后手部表皮和真皮中IgG的积累可能诱导皮肤血管周围炎症细胞浸润，导致MADSAM和MMN出现湿疹样皮疹。
