Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center
Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center
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DOI：
10.1111/trf.13200
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发表时间：
2015-11-01
期刊：
影响因子：
2.9
通讯作者：
Hsia, Cyrus C.
中科院分区：
文献类型：
--
作者：
Bharath, Vighnesh;Eckert, Kathleen;Hsia, Cyrus C.
脓毒性脑膜炎是静脉注射免疫球蛋白（IVIG）治疗的一种罕见但严重的并发症。大多数文献仅限于病例报告，因此该并发症的真实发生率尚不确定。研究设计和方法2008年1月1日至2013年12月31日，在伦敦健康科学中心（LHSC）对所有IVIG相关不良输血反应病例进行了回顾性审查。对所有报告的输血反应进行了评价，以确定IVIG引起的无菌性脑膜炎病例。所有记录的IVIG输注和腰椎穿刺在研究期间进行了审查，患者与两个干预措施被确定，并进一步审查图表进行识别无菌性meningies. CulturesDuring我们的研究期间，1324独特的患者共接受了11,907 IVIG输注（554,566克）的各种条件。确定了8例无菌性脑膜炎，表明所有患者的总发病率为0.60%，所有IVIG输注的总发病率为0.067%。患者在输注后24至48小时内出现症状，最初接受抗生素治疗。这些反应是自限性的，因为症状在5至7天内自行消退。治疗是支持性的，与随后的IVIG输注可能需要输注前药物或可能在产品formulation.CONCLUSIONThis审查IVIG引起的无菌性脑膜炎超过6年的时间确定了一个更强大的估计发病率和风险为0.60%和0.067%，所有患者和输液，分别。鉴于这种并发症可以模仿感染性脑膜炎，并导致相当大的发病率，医生需要意识到这种罕见但重要的情况。
BACKGROUNDAseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy. The majority of literature is limited to case reports, so the true incidence of this complication is uncertain.STUDY DESIGN AND METHODSA retrospective review of all cases of IVIG-associated adverse transfusion reactions was performed at London Health Sciences Centre (LHSC) from January 1, 2008, to December 31, 2013. All reported transfusion reactions were evaluated to identify cases of aseptic meningitis due to IVIG. All documented IVIG infusions and lumbar punctures performed during the study period were reviewed; patients with both interventions were identified and further chart review was performed to identify aseptic meningitis.RESULTSDuring our study period, 1324 unique patients received a total of 11,907 IVIG infusions (554,566 g) for various conditions. Eight cases of aseptic meningitis were identified, suggesting an overall incidence of 0.60% for all patients and 0.067% for all IVIG infusions. Patients presented with symptoms within 24 to 48 hours of the infusion and were treated with antibiotics initially. The reactions were self-limited, as symptoms self-resolved within 5 to 7 days. Treatment was supportive, with subsequent IVIG infusions likely requiring preinfusion medication or possibly a switch in product formulation.CONCLUSIONThis review of IVIG-induced aseptic meningitis over a 6-year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.