Observation |

Successful Treatment of Ulcerative and Diabeticorum Necrobiosis Lipoidica With Intravenous Immunoglobulin in a Patient With Common Variable Immunodeficiency

Neda Barouti, MD1; Amy Qian Cao, H BSc1,2; Donato Ferrara, MD1; Christa Prins, MD1
[+] Author Affiliations
1Department of Medical Specialties–Dermatology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
2Queen’s University School of Medicine, Kingston, Ontario, Canada
JAMA Dermatol. 2013;149(7):879-881. doi:10.1001/jamadermatol.2013.4133.
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Necrobiosis lipoidica (NL) is an idiopathic inflammatory skin disorder that rarely resolves spontaneously, and ulceration is a major complication. Although NL occurs in less than 1% of patients with diabetes mellitus, 75% of NL cases are associated with diabetes.1

Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency encountered in adults: incidence is estimated at between 1 in 10 000 and 1 in 50 000. Because of the heterogeneity of this disorder, no targeted therapy has been defined except intravenous immunoglobulin (IVIG).2 Herein, we describe a patient with diabetes who experienced a successful combined treatment of NL ulcers and CVID with IVIG.

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Figure 1.
Clinical Images of Affected Areas Before Treatment

Lower pretibial right (A) and left (B) legs before intravenous immunoglobulin therapy showing large and ulcerative plaques of necrobiosis lipoidica.

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Figure 2.
Clinical Image of Affected Areas After Treatment

Lower pretibial aspect of the legs after Intravenous Immunoglobulin therapy showing substantial healing.

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