Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) following first administration of immunoglobulin replacement

This case report describes a rare instance of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) following the first administration of intravenous immunoglobulin (Ig) in a woman in her 30s with secondary immunodeficiency from rituximab treatment for multiple sclerosis. 3 days after receiving her first dose of intravenous Ig, she developed a pruritic rash in her intertriginous regions of the body. Laboratory and dermatologic evaluation confirmed the SDRIFE diagnosis. Treatment with systemic and topical steroids led to the resolution of her symptoms and rash. This case represents one of the few reported cases of SDRIFE resulting from intravenous Ig treatment and the first to demonstrate successful continuation of immunoglobulin therapy with a change in intravenous Ig formulation. The patient has tolerated multiple subsequent infusions well, with no further rash, and with improvement in her frequency and severity of infections. This case highlights a rare complication of intravenous Ig therapy and describes a successful management to continue this critical therapy.