PMID- 37020710
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230407
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 4
DP  - 2023 Apr
TI  - Inpatient Rheumatology Consultation Prompted by Positive Autoantibodies in 
      Patients Receiving Intravenous Immunoglobulin Therapy: A Case Series and 
      Literature Review.
PG  - e37008
LID - 10.7759/cureus.37008 [doi]
LID - e37008
AB  - Intravenous immunoglobulin (IVIG) is a therapeutic preparation used in the 
      treatment of multiple diseases. Autoimmune testing with antinuclear antibody 
      (ANA) screening is often obtained for some of these conditions, but only after 
      initiation of IVIG treatment. This can present a diagnostic dilemma in 
      hospitalized patients and may trigger a rheumatology consultation. We describe 
      our consultative inpatient two-year experience with five such patients and review 
      the pertinent literature. A retrospective chart review of rheumatology inpatient 
      consultations between 6-2018 and 6-2020 at our academic tertiary care hospital 
      for post-IVIG positive serologies was performed. A pertinent literature review 
      was performed. Five patients had a positive ANA and other autoantibodies detected 
      in their serum after they received IVIG for non-rheumatological conditions. None 
      of these patients met the criteria for a connective tissue disease. The 
      literature review identified a total of 58 patients from case reports and case 
      series, several of whom tested positive for ANA and other antibodies after 
      receiving IVIG. Studies assessing specific IVIG products detected multiple 
      autoantibodies in the donor pool. Autoimmune testing is initiated on inpatients 
      receiving IVIG for non-rheumatological conditions. If an autoantibody ANA screen 
      is positive, a rheumatology consultation may be requested. In the absence of 
      pre-IVIG antibody tests it is difficult to interpret post-IVIG-positive 
      antibodies. Whether such positive antibodies are of clinicopathological 
      significance is determined by clinical judgment and time.
CI  - Copyright (c) 2023, Fnu et al.
FAU - Fnu, Zarlasht
AU  - Fnu Z
AD  - Medicine, Mather Hospital/Northwell Health, Port Jefferson, USA.
FAU - Uddin, Asif
AU  - Uddin A
AD  - Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, 
      USA.
FAU - Navetta-Modrov, Brianne
AU  - Navetta-Modrov B
AD  - Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, 
      USA.
FAU - Patnaik, Asha
AU  - Patnaik A
AD  - Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, 
      USA.
FAU - Kaell, Alan
AU  - Kaell A
AD  - Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, 
      USA.
AD  - Medicine, Zucker School of Medicine/Northwell Health, Hempstead, USA.
AD  - Medicine, Mather Hospital/Northwell Health, Port Jefferson, USA.
LA  - eng
PT  - Case Reports
DEP - 20230401
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10069874
OTO - NOTNLM
OT  - anti-nuclear antibody (ana)
OT  - autoantibodies
OT  - autoimmune hemolytic anemia (aiha)
OT  - guillain-barre syndrome (gbs)
OT  - immune thrombocytopenic purpura (itp)
OT  - intravenous immunoglobulin (ivig)
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/04/07 06:00
MHDA- 2023/04/07 06:01
PMCR- 2023/04/01
CRDT- 2023/04/06 02:08
PHST- 2023/03/31 00:00 [accepted]
PHST- 2023/04/07 06:01 [medline]
PHST- 2023/04/06 02:08 [entrez]
PHST- 2023/04/07 06:00 [pubmed]
PHST- 2023/04/01 00:00 [pmc-release]
AID - 10.7759/cureus.37008 [doi]
PST - epublish
SO  - Cureus. 2023 Apr 1;15(4):e37008. doi: 10.7759/cureus.37008. eCollection 2023 Apr.