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Acute Aseptic Meningitis Temporally Associated with Intravenous Polyclonal Immunoglobulin Therapy: A Systematic

Elisabetta L T De Felice1, Gabriel F Toti1, Beatrice Gatti1

  • 1Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.

Clinical Reviews in Allergy & Immunology
|May 13, 2024
PubMed

Insights

Intravenous immunoglobulin (IVIg) therapy can cause acute aseptic meningitis, often presenting within three days of treatment initiation. This condition typically resolves quickly after discontinuing IVIg.

Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Acute aseptic meningitis is an occasional adverse event associated with intravenous polyclonal human immunoglobulin (IVIg) therapy.
  • Previous case reports are insufficient to establish a definitive link between IVIg and meningitis.

Approach:

  • A systematic review and meta-analysis were conducted on eligible cases, case series, and pharmacovigilance studies.
  • Literature search identified 71 individual cases and eight case series involving IVIg-associated meningitis.

Key Points:

  • Meningitis onset occurred within 3 days of IVIg initiation in 90% of cases, with rapid recovery (≤7 days).
  • A link between rapid IVIg infusion and meningitis was noted in 31% of cases.
  • Cerebrospinal fluid analysis showed neutrophilic pleocytosis in 66% of cases, and recurrence was observed in 11% upon re-exposure.

Conclusions:

  • Intravenous immunoglobulin therapy is a potential cause of acute aseptic meningitis.
  • The condition is characterized by rapid onset and prompt resolution after medication cessation.
  • Pooled prevalence from case series suggests a 0.6% occurrence rate, with temporal association noted across multiple IVIg products.
Keywords:
Aseptic meningitisAutoimmune disorderDrug-induced meningitisIntravenous polyclonal human immunoglobulinMeta-analysisSystematic review

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