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The therapeutic indications for intravenous immunoglobulin (IVIg) have increased significantly in the last years. It is currently FDA approved for the treatment of primary humoral immunodeficiency syndromes, idiopathic thrombocytopenic purpura (ITP), preventively after bone marrow transplantation, in B-cell chronic lymphocytic leukemia, in pediatric HIV infection and Kawasaki syndrome [1]. However, it is also being used in at least 53 off-label conditions [2], with various strengths of evidence supporting its use. The listed adverse reactions include anaphylactic reactions (especially in patients with selective IgA deficiency), aseptic meningitis syndrome, acute renal failure, headaches, fatigue, chills, backache, leg cramps, lightheadedness, fever, urticaria, flushing, slight elevation of blood pressure, nausea and vomiting, and local pain and irritation at the infusion site [1]. Reviews on the topic of possible adverse effects also mention liver enzyme abnormalities, immune complex arthritis, hypersensitivity myocarditis, neutropenia, hypotension, encephalopathy, alopecia, uveitis, hypothermia [3], as well as acute hemolytic reactions [4], and the hyperviscosity syndrome [5]. Furthermore, there is a lowbut definitive risk that the final product can be virally contaminated with HIV, HBV, or HCV [2]. A case of transmission of parvovirus B19 has been reported [6]. There have been several cases of thromboembolic events reported in the world literature that occurred either during or in short temporal relation to IVIg infusion. Some reviews [3, 4, 7–9] mention this serious side effect; others [5, 10] do not. Our recent experience with a patient suffering a large anterior wall myocardial infarction while receiving IVIg therapy prompted us to review the current literature and to discuss possible causes and treatment options.

annals of hematology

Thromboembolic events as an emerging adverse effect during high-dose intravenous immunoglobulin therapy in elderly patients: a case report and discussion of the relevant literature