Pulmonary thromboembolism induced by intravenous immunoglobulin therapy for Stevens-Johnson syndrome: A case report

A 71-year-old man visited our department with multiple diffuse erythema on his trunk (day 1). The patient was administrated prednisolone(15 mg/day)for 3 month for an idiopathic thrombocytopenic purpura. From 1 month before his first visit to us, he had been treated with antibiotic and antifungal drugs for postoperative pneumocystis pneumonia after right outer ankle bone fracture surgery. He was diagnosed with drug eruption based on the clinical findings, and the drugs were discontinued. On the following day(day 2), the skin eruption developed into Stevens-Johnson syndrome with blisters and erosions on the whole body and mucosa. Then, he was given intravenous immunoglobulin(IVIG)therapy(400 mg/kg/day) for 5 days, and his skin condition gradually improved. However, dyspnea suddenly appeared on day 7. Pulmonary thromboembolism was confirmed. In spite of intensive care, the patient died on day 9. We should remember that IVIG therapy may cause lethal thrombosis.