Aseptic Meningitis and Intravenous Immunoglobulin Therapy

Immunoglobulin fractionated from human plasma and specifically manufactured for intravenous use has been approved by the Food and Drug Administration (FDA) for many indications. From Nolte and colleagues' original 1979 report [1] showing the usefulness of this therapy in treating primary immunodeficiencies to Imbach and coworkers' study [2, 3] showing the efficacy of the therapy compared with that of corticosteroids in the treatment of idiopathic thrombocytopenic purpura, licensed indications have been expanded to include the treatment of Kawasaki disease and the prevention of bacterial infections in persons with chronic lymphocytic leukemia. Most recently, as noted by Sekul and colleagues in this issue [4], very high doses of intravenous immunoglobulin (2 g/kg of body weight) are now being studied as a way to modulate many autoimmune diseases.

Headache, backache, flushing, chills, fever, and nausea are the most common side effects reported with infusions of intravenous immunoglobulin. The cause of these symptoms has not been determined, but the symptoms are often associated with the rapidity of the infusion and usually resolve spontaneously within 30 to 60 minutes after the infusion is stopped. The symptoms may occur with every infusion or …