Intravenous immunoglobulin–induced aseptic meningitis

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Retrospective review of 1324 unique patients receiving IVIg between 08-13 at London Health Science Centre, London, Ontario. Eight patients (0.60%) developed aseptic meningitis or 8 in 11,907 (0.067%) infusions.
Time to detection: 
Symptoms developed 1-2 days of completing IVIg infusion. Symptoms resolved within 2-7 days.
Alerting signals, symptoms, evidence of occurrence: 
Meningismus with headache or deterioration in mental status post-receiving IVIg with or without fever, nausea, vomiting, pharyngitis, photo-sensitivity, diarrhea. Lumbar puncture results: CSF culture negative, clear fluid with high protein, increased nucleated cells, neutrophilia. Negative CT scan of the head.
Demonstration of imputability or root cause: 
Extensive record review. Four of the eight patients had immune thrombocytopenic purpura (ITP). One each had demyelinating polyneuropathy, autoimmune hemolytic anemia, primary immune deficiency, myasthenia gravis.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Reference attachment: 
Suggest references: 
Incidence and natural history of intravenous immunoglobulin–induced aseptic meningitis: a retrospective review at a single tertiary care center. Bharath V et al. Transfusion. 2015 Nov;55(11):2597-605
Expert comments for publication: 
Aseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy, self-resolving and generally non fatal, therefore, treatment is supportive. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.