Intravenous Immunoglobulin-Induced Profound Bradycardia in a Patient With Idiopathic Thrombocytopenic Purpura

Raheja, Hitesh; Kumar, Varun; Hollander, Gerald; Shani, Jacob; Greenberg, Yisachar

doi:10.1097/mjt.0000000000000654

Cited by 9 publications

(6 citation statements)

References 2 publications

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“…Slowed heart rate has been documented as an adverse reaction during IVIG infusion. 22 In our patient, we thought an IVIG-induced bradycardia less likely given (1) the bradycardia did not manifest in conjunction with an infusion, but rather 24–36 hours after IVIG infusion and (2) the bradycardia was persistent for multiple days on telemetry, irrespective of whether IVIG was being given.…”

Section: Discussionmentioning

confidence: 68%

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

et al. 2021

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This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.

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Section: Discussionmentioning

confidence: 68%

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

et al. 2021

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“…In 2015, Tufekci et al ( 35 ) reported that supraventricular tachycardia occurred during IVIG administration in two newborn infants with immune hemolysis. Raheja et al ( 36 ) described a case of asymptomatic bradycardia that occurred after IVIG administration in a female with ITP who reached a lowest heart rate of 30 bpm before returning to baseline levels without any therapy. Although it is not fully understood whether arrhythmia is directly related to immunoglobulin infusion, cardiac monitoring during IVIG infusion is recommended in patients with a history of cardiac disorders.…”

Section: Classification Of Adverse Effectsmentioning

confidence: 99%

Adverse Effects of Immunoglobulin Therapy

et al. 2018

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Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.

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“…Bradycardia is known to be an extremely rare adverse event of IVIG infusion. As reported in a single case report of an adult patient, the reduction in HR occurred shortly after the start of the infusion and resolved spontaneously in less than 48 h. 23 In children with Kawasaki, the combination of IGEV with intravenous steroids increases the risk of developing bradycardia compared with IGEV alone. 24 …”

Section: Discussionmentioning

confidence: 73%

Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series

Ciccarelli

Bruzzese

Asile

et al. 2021

European Heart Journal - Case Reports

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Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. MIS-C-associated myocarditis is usually characterized by fever, tachycardia, nonspecific ECG abnormalities and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report 2 cases of patients with MIS-C-associated myocarditis who developed severe bradycardia. Case summary Two female adolescents with recent history of COVID-19 were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac Troponin 2663 pg/ml, mean NT-pro-BNP 5097 pg/ml) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest HR 36 and 42, respectively), that appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant IL-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months follow-up. Discussion In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.

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Intravenous Immunoglobulin-Induced Profound Bradycardia in a Patient With Idiopathic Thrombocytopenic Purpura

Cited by 9 publications

References 2 publications

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

Adverse Effects of Immunoglobulin Therapy

Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series

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