PMID- 28813773
OWN - NLM
STAT- MEDLINE
DCOM- 20171128
LR  - 20171128
IS  - 0038-3317 (Print)
IS  - 0038-3317 (Linking)
VI  - 70
IP  - 3
DP  - 2017 Mar
TI  - A Case of IVIG-Induced Aseptic Chemical Meningitis.
PG  - 119-121
AB  - Intravenous immunoglobulin (IVIG) is a commonly used and generally well-tolerated 
      medication. Common side effects include flu-like symptoms such as fevers, 
      headaches, myalgia, fatigue, and nausea. One of the more rare side effects is 
      aseptic meningitis, with a reported incidence rate of around 0.067 percent of all 
      IVIG infusions. In this paper, we describe a 47-year-old female patient with a 
      history of myasthenia gravis who presented with a headache, neck pain, and neck 
      stiffness while undergoing IVIG infusions for a myasthenia crisis. On admission 
      day, the patient was afebrile with stable vital signs. A physical examination 
      revealed nuchal rigidity and tenderness with no focal neurological deficits. 
      Cerebrospinal fluid (CSF) cytology noted an elevated white blood cell (WBC) count 
      of 1,138 cells/muL with a neutrophil predominance (96 percent). CSF red blood cell 
      count was unremarkable at 1 cell/muL. The patient's IVIG infusions were stopped, 
      suspecting chemical meningitis. Given the markedly elevated CSF WBC count with 
      neutrophil predominance, she was started on vancomycin and ceftriaxone to also 
      cover for bacterial meningitis. The patient's meningeal signs and symptoms 
      significantly improved 24 hours after admission. Given the clear temporal 
      relationship to IVIG administration and the rapid improvement of symptoms, 
      IVIG-induced aseptic meningitis is strongly suspected. The patient's antibiotics 
      were discontinued. Forty-eight hours after stopping IVIG and 24 hours after 
      discontinuing antibiotics, her meningitis symptoms completely resolved with the 
      use of analgesics alone. The patient was then discharged uneventfully. CSF viral 
      and bacterial studies, including a gram stain and cultures, did not result in 
      anything noteworthy. Our case presents an interesting diagnostic dilemma where 
      drug-induced (IVIG) aseptic meningitis mimics bacterial meningitis clinically and 
      on CSF analysis. The clear temporal relationship to IVIG administration and the 
      rapid resolution of symptoms upon stopping the drug can aid in the diagnosis of 
      this rare event and help doctors avoid the use of unnecessary antibiotic therapy.
CI  - Copyright(c) South Dakota State Medical Association.
FAU - Patel, Anish
AU  - Patel A
AD  - Department of Internal Medicine, University of South Dakota Sanford School of 
      Medicine.
FAU - Potu, Kalyan Chakravarthy
AU  - Potu KC
AD  - Department of Internal Medicine, University of South Dakota Sanford School of 
      Medicine.
FAU - Sturm, Tamera
AU  - Sturm T
AD  - Department of Internal Medicine, University of South Dakota Sanford School of 
      Medicine.
LA  - eng
PT  - Case Reports
PL  - United States
TA  - S D Med
JT  - South Dakota medicine : the journal of the South Dakota State Medical Association
JID - 101265265
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/*adverse effects
MH  - Meningitis, Aseptic/*chemically induced/diagnosis
MH  - Meningitis, Bacterial/diagnosis
MH  - Middle Aged
MH  - Myasthenia Gravis/drug therapy
EDAT- 2017/08/17 06:00
MHDA- 2017/11/29 06:00
CRDT- 2017/08/17 06:00
PHST- 2017/08/17 06:00 [entrez]
PHST- 2017/08/17 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PST - ppublish
SO  - S D Med. 2017 Mar;70(3):119-121.