J Rheum Dis.  2017 Apr;24(2):119-122. 10.4078/jrd.2017.24.2.119.

Aseptic Meningitis and Acute Kidney Injury after Immunoglobulin Infusion in a Patient with Systemic Lupus Erythematosus and Immune Thrombocytopenic Purpura

Affiliations
  • 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. bestmd2000@amc.seoul.kr

Abstract

A 36-yr-old woman with systemic lupus erythematosus was admitted in our center because of thrombocytopenia that was being treated with corticosteroids. She was prescribed a four-day course of intravenous immunoglobulin (IVIG) infusion. After three days of IVIG infusion, she developed aseptic meningitis with severe pleocytosis in the cerebrospinal fluid, followed by acute kidney injury. These complications resolved completely with conservative management. Here, we report these rare complications of IVIG and the outcome.

Keyword

Systemic lupus erythematosus; Acute kidney injury; Aseptic meningitis; Intravenous immunoglobulin

MeSH Terms

Acute Kidney Injury*
Adrenal Cortex Hormones
Cerebrospinal Fluid
Female
Humans
Immunoglobulins*
Immunoglobulins, Intravenous
Leukocytosis
Lupus Erythematosus, Systemic*
Meningitis, Aseptic*
Purpura, Thrombocytopenic, Idiopathic*
Thrombocytopenia
Adrenal Cortex Hormones
Immunoglobulins
Immunoglobulins, Intravenous

Figure

  • Figure 1 Brain magtenic resonance imaging (A) contrast-enhanced T1-weighted image: no leptomeningeal enhancement, (B) fluid-attenuated inversion recovery image: no hyperintense signal in cerebrospinal fluid space.

  • Figure 2 Change of platelet count. (A) Before admission. (B) After admission. YA: years ago, PD: prednisolone, IVIG: intravenous immunoglobulin, ADM: admission, HD: hospital day.


Reference

1. Newman K, Owlia MB, El-Hemaidi I, Akhtari M. Management of immune cytopenias in patients with systemic lupus erythematosus - Old and new. Autoimmun Rev. 2013; 12:784–791.
2. Hansen RJ, Balthasar JP. Mechanisms of IVIG action in immune thrombocytopenic purpura. Clin Lab. 2004; 50:133–140.
3. Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases. N Engl J Med. 2012; 367:2015–2025.
4. Duhem C, Dicato MA, Ries F. Side-effects of intravenous immune globulins. Clin Exp Immunol. 1994; 97:Suppl 1. 79–83.
5. Stiehm ER. Adverse effects of human immunoglobulin therapy. Transfus Med Rev. 2013; 27:171–178.
6. Bharath V, Eckert K, Kang M, Chin-Yee IH, Hsia CC. Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center. Transfusion. 2015; 55:2597–2605.
7. Kemmotsu Y, Nakayama T, Matsuura H, Saji T. Clinical characteristics of aseptic meningitis induced by intravenous immunoglobulin in patients with Kawasaki disease. Pediatr Rheumatol Online J. 2011; 9:28.
8. Jain RS, Kumar S, Aggarwal R, Kookna JC. Acute aseptic meningitis due to intravenous immunoglobulin therapy in Guillain-Barré syndrome. Oxf Med Case Reports. 2014; 2014:132–134. DOI: 10.1093/omcr/omu051. eCollection 2014.
9. Fakhouri F. Intravenous immunoglobulins and acute renal failure: mechanism and prevention. Rev Med Interne. 2007; 28(Spec No. 1):4–6.
10. Ahsan N. Intravenous immunoglobulin induced-nephropathy: a complication of IVIG therapy. J Nephrol. 1998; 11:157–161.
11. Angeli P, Scaglione F. Nephrotoxicity of intravenous immunoglobulin in the setting of liver transplantation or HBV-related cirrhosis: an undervalued topic. Minerva Gastroenterol Dietol. 2008; 54:259–275.
12. Levy JB, Pusey CD. Nephrotoxicity of intravenous immunoglobulin. QJM. 2000; 93:751–755.
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