High-dose intravenous immunoglobulin infusion in polyarteritis nodosa

We describe a 58-year-old Japanese female who developed polyarteritis nodosa (PN). Her skin disease and systemic symptoms were resistant to dapsone (1.5 mg kg⁻¹ day⁻¹), high-dose oral prednisone (1 mg kg⁻¹ day⁻¹) and azathioprine (2 mg kg⁻¹ day⁻¹), and intravenous cyclophosphamide pulse therapy (10 mg kg⁻¹ day⁻¹). She was ultimately treated with infusion of high-dose intravenous immunoglobulin (IVIG) at a dose of 0.1 g kg⁻¹ daily for five consecutive days weekly for a period of 12 weeks, resulting in remission of his cutaneous and systemic symptoms and successful tapering of his prednisone and azathioprine dose. However, 12 months later, relapsing fever and polyarthritis recurred, and eventually, 24 months later, indurated erythema and punched-out ulcers appeared on the lower legs. These symptoms were reduced after increasing the dose of oral prednisone (1 mg kg⁻¹ day⁻¹). Our case indicates that the high-dose IVIG infusion therapy may be useful for controlling PN in certain periods since the long-term observation revealed deterioration of symptoms. We review related articles and discuss its effectiveness in PN.