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A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
Acute stroke with high-dose intravenous immune globulin
David A White1, Mandy C Leonard
1Drug Information Services and Formulary Management, Department of Pharmacy, The Cleveland Clinic Foundation, Cleveland, OH 44195-5245, USA. whited1@ccf.org
Summary
Acute stroke occurred in a patient treated with high-dose intravenous immune globulin (IVIG) for dermatomyositis. Close monitoring and adjusted infusion rates/dosages are recommended during IVIG therapy to mitigate stroke risks.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Dermatomyositis is an autoimmune disease often treated with immunosuppressive therapies.
- Intravenous immune globulin (IVIG) is an increasingly utilized treatment for various autoimmune and inflammatory conditions.
- Adverse events, including thrombotic events, have been rarely associated with IVIG administration.
Observation:
- A 43-year-old woman with dermatomyositis experienced acute stroke symptoms, including facial droop and hemiplegia, during her first IVIG infusion.
- The patient had previously developed a severe adverse reaction to prednisone.
- Imaging revealed a significant right internal carotid artery occlusion and a large right-middle cerebral artery infarct with basal ganglia hemorrhage.
Findings:
- The patient's stroke was determined to be a probable adverse drug event related to IVIG administration, based on the Naranjo probability scale.
- This case highlights a rare but serious complication associated with IVIG therapy.
- The stroke occurred despite initial treatment with prednisone, which was discontinued due to adverse reactions.
Implications:
- Healthcare providers should consider the risk of stroke and thrombosis in patients receiving IVIG, particularly those with pre-existing risk factors.
- Slower infusion rates and lower dosages of IVIG may help reduce the incidence of thrombotic complications.
- Enhanced vigilance and monitoring during IVIG infusions are crucial for early detection and management of potential neurological adverse events.
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