Which IV therapy for SJS/TEN is associated with a boxed warning for thromboembolism and acute kidney injury?

• A. IVIG
• B. Systemic steroids
• C. Cyclosporine
• D. Thalidomide

Answer: (A)

The main concept here is recognizing that intravenous immunoglobulin (IVIG) has serious safety warnings that influence its use. IVIG carries a boxed warning for thromboembolism and acute kidney injury, reflecting the possibility of blood clots and kidney damage with IVIG, especially at high doses or with certain formulations. These risks arise because IVIG can increase blood viscosity and, in some products, cause renal injury, with higher risk in older patients, those with dehydration or preexisting kidney disease, and when infusions are given too rapidly. In the context of SJS/TEN, IVIG is used for its immunomodulatory effects, but this safety signal means clinicians must monitor hydration, renal function, and signs of thrombosis and select patients carefully. The other therapies have different risk profiles (steroids raise infection risk and hyperglycemia; cyclosporine is notably nephrotoxic; thalidomide has teratogenicity and other side effects) and do not share this specific boxed warning for thromboembolism and AKI.