LETTER
Meningitis and Skin Reaction after Intravenous Immune Globulin Therapy
E. Peter Gabor, MD
15 December 1997 | Volume 127 Issue 12 | Page 1130
TO THE EDITOR:
In his excellent review of high-dose intravenous immune globulin (IVIg) therapy for neurologic diseases, Dalakas [1] states that aseptic meningitis complicating the administration of IVIg responds to analgesics and subsides in 24 to 48 hours and that further diagnostic testing is rarely necessary. In our experience, the symptoms of severe meningeal irritation, high temperature, and vomiting in such cases mandate at least a lumbar puncture for cerebrospinal fluid analysis and possibly other tests. Even if one suspects that meningism could be due to administration of IVIg rather than coincident with it, the possibility of bacterial meningitis should be ruled out [2]. More important, we have seen three cases similar to the one we described in 1995 [2] that had a protracted, difficult course requiring 9 to 14 days of hospitalization. This is contrary to Dalakas's experience.
Although this occasional complication should not detract from the value of IVIg therapy, neither should it be taken lightly when the risk–benefit ratio is considered in therapeutic decision making.
It is notable that we have never observed this complication when IVIg was given in any dose to IgG-deficient patients with lymphoproliferative diseases, such as chronic lymphocytic leukemia, or paraproteinemias, such as multiple myeloma.
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Author and Article Information
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University of California, Los Angeles, School of Medicine; Beverly Hills, CA 90212
1. Dalakas MC. Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med. 1997; 126:721-30.
2. Gabor EP. Intravenous immune globulin. West J Med. 1995; 162:277-8.
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