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The I.V.I.G infusion in this patient carries more adverse reactions more than other cases as multiple myeloma patient has an increased viscosity (increased serum viscosity) so our decision taken by a multidisciplinary team included his treating oncologist as the patient did not improved on systemic steroid only although he was on proper dose according to his body weight and his condition worsen with time even after discontinue the possible culprit drugs and there was internal orange involvement, so I.V.I.G infusion was mandatory [33]