When the Treatment Becomes the Problem: A Case of Paradoxical Case Effects of IVIG

Intravenous immunoglobulin (IVIG) is commonly used for immunomodulation in autoimmune diseases but can induce rare complications, such as hemolytic anemia. We report a case of a 19-year-old woman with Crohn disease complicated by pyoderma gangrenosum, presenting with IVIG-induced hemolytic anemia and a distinctive rash. Following two doses of IVIG, she experienced headaches, rash, and tachycardia. Laboratory findings showed anemia, hyperbilirubinemia, and a positive Coombs test. She was managed with supportive care. This case underscores the need for vigilant monitoring for hemolysis in patients receiving IVIG, especially those with cumulative doses and underlying inflammatory conditions.