Abstract
Intravenous immunoglobulins (IVIgs) are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4–6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI). The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization). This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.
Highlights
Intravenous immune globulin (IVIg) is a solution of human plasma-derived immunoglobulins of over a thousand donors containing an extensive range of immune antibodies which may serve in protecting against human pathogens and foreign antigens
Its capacity to exert a variety of immunomodulating activities has led to the growing use of IVIg in treating several immunemediated disorders and autoimmune diseases such as systemic lupus erytematous (SLE), antiphospholipid syndrome (APS), pemphigus, idiopathic thrombocytopenic purpura (ITP), multiple sclerosis (MS), myasthenia gravis (MG), Kawasaki syndrome, dermatomyositis (DM) polymyositis (PM), juvenile dermatomyositis (JDM), systemic vasculitides, adult Still’s disease, prevention of graft-versus-host disease in recipients of allogeneic bone marrow transplants, intestinal bleeding due to Henoch-Schonlein purpura and in recurrent abortions [2,3,4,5,6,7,8,9,10]
We report a case of probable IVIg-induced acute myocardial infarction (MI) occurring during treatment for myasthenia gravis
Summary
Intravenous immune globulin (IVIg) is a solution of human plasma-derived immunoglobulins of over a thousand donors containing an extensive range of immune antibodies which may serve in protecting against human pathogens and foreign antigens. Its capacity to exert a variety of immunomodulating activities has led to the growing use of IVIg in treating several immunemediated disorders and autoimmune diseases such as systemic lupus erytematous (SLE), antiphospholipid syndrome (APS), pemphigus, idiopathic thrombocytopenic purpura (ITP), multiple sclerosis (MS), myasthenia gravis (MG), Kawasaki syndrome, dermatomyositis (DM) polymyositis (PM), juvenile dermatomyositis (JDM), systemic vasculitides, adult Still’s disease, prevention of graft-versus-host disease in recipients of allogeneic bone marrow transplants, intestinal bleeding due to Henoch-Schonlein purpura and in recurrent abortions [2,3,4,5,6,7,8,9,10] The majorities of these adverse effects attributed to IVIg are mild, self-limited, and related to the speed of infusion. We report a case of probable IVIg-induced acute MI occurring during treatment for myasthenia gravis
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