Abstract
IntroductionInfectious complications represent a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). The etiology is postulated to be secondary to aberrations in cell-mediated immunity, as well as to therapy-related immunosuppression. Hypogammaglobulinemia, which occurs in virtually all patients with CLL, may be profound and correlates with disease duration and stage. Intravenous immunoglobulin (IVIG) therapy has been used successfully to prevent and treat infections in this cohort of patients. However IVIG administration and treatment is not benign and should be used with caution given the potential manifestations of thromboembolic complications. High concentration and rapid infusion rate of the IVIG, as well as increased dose and osmolarity of the solution are thought to predispose to thrombotic events. Serum viscosity is the implicated mechanism for compromised blood flow and predisposition of high-risk patients to cardiovascular or cerebrovascular infarction. We report a case of IVIG related thromboembolic manifestations in a CLL patient, to highlight the importance of risk stratifying patients prior to treatment administration.Case presentationWe present a 55-year-old Caucasian man with CLL who presented to our clinic with neutropenic fevers following a cycle of chemotherapy. Laboratory parameters revealed hypogammaglobulinemia prompting IVIG administration. Shortly thereafter, he developed a massive cascade of thromboembolic phenomena precipitating his demise.ConclusionThe current consensus surrounding IVIG is that of a relatively safe treatment, with minor adverse effects such as hypertension, fever and chills, nausea, myalgias, or headache. However our report highlights the importance of proceeding with caution in the application of this therapy, as it's proclivity for thrombotic complications has not been fully elucidated in patients with underlying malignancies. Pre-existing thrombogenic risk factors should be carefully evaluated in patients undergoing treatment with IVIG. Clinical evaluation, with careful attention to vascular history and underlying co-morbidities can potentially unmask the high-risk patient where IVIG could be lethal.
Highlights
Infectious complications represent a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL)
Our report highlights the importance of proceeding with caution in the application of this therapy, as it's proclivity for thrombotic complications has not been fully elucidated in patients with underlying malignancies
In 1981 during treatment of two children with hypogammaglobulinemia and coincidental idiopathic thrombocytopenic purpura (ITP), physicians in Switzerland observed a reproducible increase in the platelet count following Intravenous immunoglobulin (IVIG) treatment
Summary
IVIG has more often been considered a safe medication, with minor adverse effects such as hypertension, fever and chills, nausea, myalgia or headache. MFiugruarl eTh1rombus in Left Ventricle Mural Thrombus in Left Ventricle. IFnifgaurcrteB3ilateral Parietal Lobes Infarct Bilateral Parietal Lobes. In terms of obtaining consent for publication, all reasonable attempts to gain consent have been made. The patient's of kin reside overseas and as a result establishing contact has been unsuccessful. We declare that the patient is anonymous and we have no reason to believe that the patient or their family would object to this publication. We briefly mentioned the potential of writing up a case report when the patient was still alive, and the family felt that if it would benefit medical practice, they would support our efforts
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