Cerebral infarction following intravenous immunoglobulin therapy for myasthenia gravis

Intravenous immunoglobulins contain naturally occurring antibodies that mimic antineutrophil cytoplasmic antibodies and activate neutrophils in a TNFα-dependent and Fc-receptor–independent way

“…Despite considerable improvements in the generation of IVIg preparations, a variety of adverse effects have been reported. [9][10][11][12][13][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]41,[54][55][56] Some of these side effects have been ascribed to the low content of IgG oligomers (aggregates) and dimers in the preparations that increase upon storage. Activation of the respiratory burst, generation of PAF, and degranulation of neutrophils can be triggered by IgG dimers and oligomers via Fc␥ RIIa receptors 57,58 without complexation to antigens and are thus believed to trigger some of the known clinical side effects.…”

“…[9][10][11][12] There are some mild common side effects like headache, fever, and chills, which are mainly transitory in nature and often related to the speed of infusion. 4,[13][14][15] However, potentially serious side effects such as ischemic encephalopathy, [16][17][18][19] cerebral infarction, [20][21][22][23][24][25][26][27] and aseptic meningitis [28][29][30][31][32][33] have been reported in patients treated with IVIg. These side effects are not uncommon.…”

Strokes after intravenous gamma globulin: Thrombotic phenomenon in patients with risk factors or just coincidence?

“…More recently, cases of acute myocardial infarctions [9][10][11][12][13] and thrombotic events, some fatal [14][15][16][17][18][19], have also been observed. Moreover, cases of strokes following immunoglobulin infusion have been reported, with a higher incidence in the elderly [20][21][22][23][24][25]. Predisposing risk factors vary from atherosclerosis and age to hyperviscosity conditions such as polycythemia vera [20] and monoclonal gammopathy [26,27].…”

“…A second case, a 27-year-old female with myasthenia gravis and migraine headaches, developed headache, fever, nausea, and vomiting after the 4 th dose of a 5-day cycle of IVIG and subsequently presented with bilateral cerebral thrombotic infarctions. Evaluation excluded any source of emboli or vasculitis [23]. In a large recent series of 498 hospitalized patients receiving IVIG over 4 years, only 3 (0.6%) developed an associated stroke.…”

Intravenous Immunoglobulin Therapy for Diabetic Amyotrophy.

“…Our patient, who had renal failure and hypertension, received a reduced dose of IVIg (0.4 g/kg/day for three days) for fear of congestive heart failure, which was still sufficiently ef- fective. Strokes, myocardial infarction and pulmonary embolism have been reported in elderly or hypertensive patients ( 16,17). Our patient suffered from ischemic stroke, but it occurred 20 weeks after the therapy.…”