Intravenous immunoglobulin as a therapy for severe or steroid-recalcitrant erythema multiforme major: a case series

Erythema multiforme (EM) is typically self-limiting, however severe EM major may cause significant morbidity and lacks evidence-based therapeutic guidelines. Intravenous immunoglobulin (IVIg) has primarily been used in recurrent EM. This study evaluates IVIg use in severe first-episode or steroid-recalcitrant EM major. A retrospective analysis reviewed six EM major patients treated with IVIg at a tertiary Australian hospital. IVIg was administered in eight instances. Disease triggers included Mycoplasma pneumoniae in three admissions, unknown aetiology in three admissions, rhinovirus/influenza A in one admission, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) in one admission. Two patients developed recurrent EM. All patients received systemic corticosteroids. All patients received IVIg within four days of admission, demonstrating complete response to therapy with a mean improvement time of 4.75 days. IVIg was well-tolerated and demonstrated efficacy in severe or corticosteroid-refractory EM major. Further studies are required to validate its efficacy.