[Tako-Tsubo syndrome during normal human immunoglobolin perfusion]

Area of Science:

• Cardiology
• Neurology
• Immunology

Background:

• Myasthenia gravis is an autoimmune disorder affecting neuromuscular junctions.
• Human Normal Immunoglobulin (Tegeline®) is used to treat various autoimmune and immune-mediated conditions.
• Tako-Tsubo syndrome, or stress-induced cardiomyopathy, presents with symptoms mimicking myocardial infarction.

Observation:

• An 82-year-old female patient with myasthenia gravis received Human Normal Immunoglobulin (Tegeline®).
• Post-treatment, she experienced dyspnea and chest pain, with ECG changes (inverted T wave) and elevated cardiac biomarkers (Troponin T, Pro-BNP).
• Coronary angiography revealed apical hypokinesia, while cardiac MRI excluded other cardiac pathologies.

Findings:

• Diagnostic workup, including Mayo Clinic criteria, strongly suggested Tako-Tsubo syndrome.
• The cardiac event was temporally associated with the administration of Human Normal Immunoglobulin (Tegeline®).
• Cardiac biomarkers and imaging findings were consistent with stress-induced cardiomyopathy.

Implications:

• This case highlights a potential, albeit rare, adverse cardiac event associated with Human Normal Immunoglobulin (Tegeline®) therapy.
• Clinicians should be aware of the possibility of Tako-Tsubo syndrome in patients treated with this immunoglobulin.
• Further investigation may be warranted to understand the mechanism linking immunoglobulin therapy to Tako-Tsubo syndrome.