Dyshidrotic Eczema following Intravenous Immunoglobulin Therapy in Guillain-Barré Syndrome: A Case Report.

INTRODUCTION: Dyshidrotic eczema is an uncommon but recognized cutaneous adverse reaction to intravenous immunoglobulin (IVIG) therapy, particularly among patients treated for immune-mediated neurological disorders such as Guillain-Barré syndrome (GBS). The eruption typically consists of pruritic vesicles on the palms and soles, arising within days to weeks after infusion. Although usually self-limited, the reaction may recur with subsequent IVIG courses and can influence therapeutic decision-making.

CASE PRESENTATION: We report a 39-year-old man newly diagnosed with GBS who was treated with standard-dose IVIG (2 g/kg over 5 days). Three days after completing therapy, he developed intense pruritus and burning of the palms, followed by the appearance of numerous deep-seated vesicles symmetrically distributed along the lateral digits and central palms. There was no systemic involvement, pustulation, or exposure to irritants. A diagnosis of IVIG-induced dyshidrotic eczema was made based on the temporal association, typical morphology, and exclusion of alternative causes. The patient responded well to high-potency topical corticosteroids, antihistamines, and emollients, with complete resolution in 2 weeks and no recurrence at 1-month follow-up.

CONCLUSION: This case highlights dyshidrotic eczema as a benign yet clinically relevant dermatologic complication of IVIG therapy in GBS. Prompt recognition allows effective management and helps avoid unnecessary diagnostic workup or treatment interruption. Awareness of this reaction is important when counseling patients and planning future IVIG use.