Acute Ischemic Stroke related to Intravenous Immunoglobulin

Authors

  • Theerawaj Gomolplitinant Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Pirada Witoonpanich Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University

Keywords:

Thromboembolic, immunoglobulin, q, ischemic stroke

Abstract

A 26-year-old man with a history of Philadelphia chromosome (Ph)-negative B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) and prior chemotherapy and stem cell transplant was admitted due to thrombocytopenia and diffused interstitial bone marrow infiltration by atypical immature mononuclear cell. After being treated with chemotherapy, the patient developed prolonged fever despite getting antibiotics. Bronchoscope was done and human metapneumovirus pneumonia due to hypogammaglobulinemia was diagnosed. Three days after the 5 days course of IVIg, the patient developed sudden deterioration of consciousness and right hemiparesis. Imaging studies showed large left internal carotid artery (ICA) territory infarction. He died 4 days after the onset of stroke.

References

Shoenfeld Y, Katz U. IvIg therapy in autoimmunity and relateddisorders: our experience with a large cohort of patients. Autoimmunity 2005, 38:123-37.

Dalakas MC, Clark WM. Strokes, thromboembolic events, and IVIg: rare incidents blemish an excellent safety record. Neurology. 2003; 60:1736-7.

Zaidan R, Al Moallem M, Wani BA, Shameena AR, Al Tahan AR, Daif AK, et al. Thrombosis complicating high dose intravenous immunoglobulin: report of three cases and review of the literature. European journal of neurology. 2003 Jul;10(4):367-72.

Nomura E, Kohriyama T, Matsumoto M, Kobayashi S. Clinical characteristics of first-ever atherothrombotic infarction or lacunar infarction with hyperlipidemia
(J-STARS-C): an analysis of data from the stroke data bank of Japan. Internal medicine. 2005 Dec;44(12):1252-7.

Caress JB, Cartwright MS, Donofrio PD, Peacock JE, Jr. The clinical features of 16 cases of stroke associated with administration of IVIg. Neurology. 2003 Jun 10;60(11):1822-4.

Vucic S, Chong PST, Dawson KT, Cudkowicz M, Cros D. Thromboembolic Complications of Intravenous Immunoglobulin Treatment. Eur Neurol 2004;52:141–144.

Jordan SC, Toyoda M. Treatment of autoimmune diseases and systemic vasculitis with pooled human intravenous immune globulin. Clin Exp Immunol. 1994; 97(suppl 1):31-8.

Cannon M, Samir M, Gerald A. Thromboembolic complications of intravenous immunoglobulin (IVIG) in an immunocompromised patient with Chronic Lymphocytic Leukemia: a case report. Cases Journal 2009, 2:9078.

Ramirez E, Romero-Garrido JA, Lopez-Granados E, Borobia AM, Perez T, Medrano N, et al. Symptomatic thromboembolic events in patients treated with intravenousimmunoglobulins: results from a retrospective cohort study. Thrombosis research. 2014 Jun;133(6):1045-51.

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Published

2019-02-13

How to Cite

1.
Gomolplitinant T, Witoonpanich P. Acute Ischemic Stroke related to Intravenous Immunoglobulin. J Thai Stroke Soc [Internet]. 2019 Feb. 13 [cited 2024 Jul. 21];17(3):44-8. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172081

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Original article