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Incidence and natural history of intravenous immunoglobulin–induced aseptic meningitis: a retrospective review at a single tertiary care center
Author(s) -
Bharath Vighnesh,
Eckert Kathleen,
Kang Matthew,
ChinYee Ian H.,
Hsia Cyrus C.
Publication year - 2015
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13200
Subject(s) - aseptic meningitis , medicine , incidence (geometry) , complication , meningitis , adverse effect , pediatrics , retrospective cohort study , lumbar puncture , natural history , surgery , aseptic processing , anesthesia , cerebrospinal fluid , physics , optics
BACKGROUND Aseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy. The majority of literature is limited to case reports, so the true incidence of this complication is uncertain. STUDY DESIGN AND METHODS A retrospective review of all cases of IVIG‐associated adverse transfusion reactions was performed at London Health Sciences Centre (LHSC) from January 1, 2008, to December 31, 2013. All reported transfusion reactions were evaluated to identify cases of aseptic meningitis due to IVIG. All documented IVIG infusions and lumbar punctures performed during the study period were reviewed; patients with both interventions were identified and further chart review was performed to identify aseptic meningitis. RESULTS During our study period, 1324 unique patients received a total of 11,907 IVIG infusions (554,566 g) for various conditions. Eight cases of aseptic meningitis were identified, suggesting an overall incidence of 0.60% for all patients and 0.067% for all IVIG infusions. Patients presented with symptoms within 24 to 48 hours of the infusion and were treated with antibiotics initially. The reactions were self‐limited, as symptoms self‐resolved within 5 to 7 days. Treatment was supportive, with subsequent IVIG infusions likely requiring preinfusion medication or possibly a switch in product formulation. CONCLUSION This review of IVIG‐induced aseptic meningitis over a 6‐year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.