Acute Myocardial Infarction following Intravenous Immunoglobulin Therapy for Chronic Inflammatory Demyelinating Polyneuropathy in Association with a Monoclonal Immunoglobulin G Paraprotein

Stamboulis, Eleftherios; Theodorou, Virginia; Kilidireas, Kostas; Αποστολου, Θωμασ

doi:10.1159/000075091

Cited by 9 publications

(11 citation statements)

References 8 publications

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“…had reported that patients treated with IvIg had a higher rate of thrombotic complications compared with those who were not (3·8% vs. 0·6%). However, until now, IvIg‐induced severe adverse events, and particularly thrombotic manifestations, were usually considered to be rare 3–47 . Our literature search using the Medline database (1966–2005) identified 92 cases of IvIg‐associated thrombosis, which have been reported in 40 articles published from 1986 to 2005 (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…However, with the wider use of IvIg in the treatment of autoimmune disorders, severe side‐effects have also been reported to occur in IvIg‐treated patients, especially acute renal tubular necrosis, aseptic meningitis, anaphylaxis in patients with IgA deficiencies and IgA antibodies, and thrombotic manifestations 3,6–9,13–18 . In limited neurological series, the incidence of thrombotic complications has indeed been estimated to be as high as 1·1–4·5% in patients receiving IvIg 3–9,12,13,16,17,19–47 …”

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confidence: 99%

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Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature

Marie¹,

Maurey²,

Hervé³

et al. 2006

British Journal of Dermatology

174

132

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Our study demonstrates that IvIg-related thrombotic arterial/venous complications are not uncommon in patients with autoimmune disorders (13% of patients). Nevertheless, patients, who are followed up in Departments of Internal Medicine often have concomitant disorders placing them at increased risk to develop IvIg-related thrombotic complications; the latter may also explain the high rate of IvIg-related thrombosis in our cohort. Our series further indicates that patients should be monitored closely for these types of adverse events during the whole period of IvIg therapy, as thrombotic manifestations occurred in patients who had received multiple IvIg infusions without exhibiting complications. In addition, our results suggest that it is questionable to initiate IvIg therapy in patients presenting with predictive factors of thrombotic complications; in this subgroup of patients, IvIg should be prescribed cautiously, after re-weighing risk-benefit considerations.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature

Marie¹,

Maurey²,

Hervé³

et al. 2006

British Journal of Dermatology

174

132

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“…These phlogistic reactions can often be prevented by slower infusion rate. Caution is mandatory, however, as some of these symptoms can herald more severe adverse reactions, such as anaphylaxis (41), stroke (42), myocardial infarction (43), deep venous thrombosis (44) or pulmonary embolization (45), aseptic meningitis (46) and in insufficiently hydrated patients or in those using sucrose‐stabilized products acute renal failure (47). The prevalence of anaphylaxis may be increased in patients with the presence of high‐titre IgG anti‐IgA antibodies (48), but the role of anti‐IgA antibodies in causing anaphylaxis in IgA‐deficient patients receiving IgG replacement therapy remains controversial (49).…”

Section: Current Treatment Options Of Primary B‐cell Defectsmentioning

confidence: 99%

Modern management of primary B‐cell immunodeficiencies

Hoernes

Seger

Reichenbach

2011

Pediatric Allergy Immunology

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B-cell defects constitute the majority of primary immunodeficiencies. Although a heterogeneous group of diseases, all are characterized by the reduction in or absence of immunoglobulins and/or specific antimicrobial antibodies. Substitution of immunoglobulin G (IgG) is therefore the mainstay of treatment. While from the late 1970s, the intravenous route of administration was the most common, in the past decades, subcutaneous immunoglobulin replacement therapy has become more popular among patients and physicians. Independently of the optimal route of administration, dosage and IgG trough level remain subjects of debate. Higher IgG trough levels seem to improve the protection against recurrent infections and thus better prevent complications such as bronchiectasis. Some patients, however, achieve protection with IgG trough levels on the lower IgG limit of healthy persons. Therefore, an individual protective IgG trough level needs to be defined for each patient. Use of additional prophylactic antibiotics and immunosuppressive drugs differs amongst specialized immunodeficiency centres and clearly requires future investigation in multi-centre trials. Haematopoietic stem cell transplantation (HSCT) is to date indicated as curative treatment in certain patients with B-cell defects associated with cell deficiencies, for example in two class-switch recombination defects and in selected severe forms of common variable immunodeficiency.

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“…No large series has reported this association, however, most of the information comes from individual case reports. There are at least 17 reports of an MI complicating IGIV therapy in the English literature [70,72,73,[81][82][83][84][85][86][87][88][89][90]. Multiple IGIV preparations have been associated with this side effect.…”

Section: Myocardial Infarctionmentioning

confidence: 99%