Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa

A 57-year-old male patient suffered from polyarteritis nodosa. He presented with articular pain, polyneuropathy, subcutaneous nodules and nodes on the lower legs. After several immunosuppressive agents (methotrexate, mycophen olate mofetil and prednisolone) had proven to be ineffective, 2 g intraveno us immunoglobulin (IVIG) per kilogram body weight were administered within 2 days in combination with 10 mg prednisolone per day. Subsequently, 6 cycl es of IVIG were applied in increasing intervals from 4 to 6 weeks resulting in a minimum dosage of 0.33 g/kg/week IVIG. The polyarteritis improved wit hin a few days after the first IVIG application. The intensity of polyneuro pathy and arthralgia of polyarteritis decreased during the period of IVIG t reatment. Finally, a dose reduction of less than 0.25 g/kg/week IVIG result ed in recurring polyarteritis nodosa, which could not be controlled by furt her administration of IVIG. Therefore, our data indicate that: (1) IVIG is partially effective in cases of polyarteritis nodosa, but the therapeutic e ffect is only transient; (2) the success of treatment may be correlated wit h the dose of IVIG per body weight and week; (3) the efficacy/cost ratio of IVIG in polyarteritis nodosa appears to be low. Copyright (C) 2001 S. Karg er AG, Basel.