Strokes after intravenous gamma globulin: Thrombotic phenomenon in patients with risk factors or just coincidence?

Abstract

We report the case of an 82-year-old woman with a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) for more than 10 years, who developed an ischemic stroke during infusion of immunoglobulin (IVIG). She had received IVIG intermittently for several years, and the previous 86 doses were well tolerated. Thromboembolism was suspected based on magnetic resonance angiogram and on further extension of the deficit after 4 days of evolution. Strokes were associated with the use of IVIG in different clinical circumstances. Pre-existing thrombogenic risk factors should be carefully considered for patients undergoing treatment with IVIG. Clinical evaluation, with attention to history, a focused vascular work-up, and looking for markers of dehydration, can identify the high-risk patient for whom a careful analysis of the risk/benefit ratio is warranted.