Use of intravenous immunoglobulin in patients with active vasculitis associated with concomitant infection

The vasculitides are a heterogeneous group of diseases, comprising necrotizing and nonnecrotizing vessel diseases. Patients with vasculitis frequently develop infections, mainly as a consequence of treatments prescribed to treat their disease. Corticosteroids, immunosuppressants, and most immunomodulating agents (eg, anti–tumor necrosis factor or anti-CD20 monoclonal antibodies) facilitate infections, and combined therapies further increase that risk.1 In immunosuppressed patients, infections are sometimes life threatening and are one of the major causes of deaths.1 However, active vasculitis and infection can coexist, and treatment for these conditions is a challenge for physicians. Therefore, alternative therapeutic approaches rather than conventional immunosuppressants are needed to limit the disease activity when a concomitant infection is suspected. Intravenous immunoglobulin (IVIG) has been used as a replacement therapy in patients with primary and secondary immunodeficiencies and in the treatment of many autoimmune and systemic inflammatory disorders.2 Moreover, their potential role against infections has been speculated.3 In the spectrum of systemic vasculitis, there is clear evidence of the benefit of IVIG in Kawasaki disease, and it is now also considered a therapeutic option in refractory antineutrophil cytoplasmic antibody–associated vasculitis.4, 5 For other vasculitis, such as polyarteritis nodosa, Henoch-Schönlein purpura (HSP), or Behçet disease (BD), only a few case reports have described a beneficial effect of IVIG.