Table 1 Reported cases with development of ischemic stroke after intravenous immunoglobulin therapy
References | Age/sex | Underlying disease | Baseline platelet count (×109/L) | Indication for IVIg therapy | IVIg dosage | Duration between time of IVIg initiation and ischemic stroke occurrence | Brain imaging findings | Outcomes |
|---|---|---|---|---|---|---|---|---|
Sztajzel 1999 [10] | 46-year-old female | Guillain-Barré syndrome | NR | Severe polyradiculoneuropathy | 0.4 g/kg/day for 5 days | 5 days | Bilateral hypodensities in the capsulolenticular regions | Motor full recovery, but memory difficulties and impairment of the executive functions |
Alexandrescu 2005 [9] | 82-year-old male | CIDP | 190 | Monthly IVIg administration for CIDP treatment (previously treated with IVIg of 86 doses without any adverse reactions) | 50 g, single dose | Several hours | Large frontoparietal infarct involving the white and gray matter and basal ganglia, without hemorrhage | Partial recovery |
Milani 2009 [8] | 55-year-old male | Chronic lymphocytic leukemia | 170 | Hypogammaglobulinemia (previously tolerated multiple infusions of IVIg without any adverse reactions) | 0.4 g/kg (30 g), single dose | 12 hours | Cerebral infarcts seen within the left posterior middle cerebral artery distribution, bilateral high parietal loops, and bilateral occipital lobes | Deceased |
Chang 2014 [13] | 44-year-old male | Miller Fisher syndrome | NR | Miller Fisher syndrome treatment | 0.4 g/kg/day for 5 days, total 180 g | 3 weeks | Acute left parieto-occipital infarct with hemorrhagic transformation and perilesional edema | Partial recovery |
Our patient | 49-year-old female | ITP, DM, HT, hyperthyroidism | 3 | Active ITP with large hematoma at right buttock | 1 g/kg/day (60 g), single dose | 12 hours | Extensive acute ischemic changed and hemorrhagic transformation in bilateral asymmetrical cerebral white matter as well as left basal ganglion and cerebral peduncle | Deceased |