Neurological complications of intravenous immunoglobulin (IVIg) therapy: An illustrative case of acute encephalopathy following IVIg therapy and a review of the literature

We report the case of a 73-year-old man who developed an acute encephalopat hy during IVlg therapy for AIDE! The signs and symptoms of the encephalopat hy completely resolved after discontinuation of the treatment. We also revi ewed the literature over the major neurological complications of IVlg thera py, including aseptic meningitis, cerebral infarction, and acute encephalop athy. About 30 cases of aseptic meningitis are reported. They are probably related to an immunoallergic reaction caused by the entry of the exogenous IgG into the CSF compartment. CSF examinations usually show a neutrophilic or a mixed pleocytosis. Three cases of cerebral infarction and 2 patients w ith acute encephalopathy, following IVlg therapy, were also reported in the literature. Cerebral vasospasm, cerebral vasculitis, and/or serum hypervis cosity may be implicated in the pathogenesis of these neurological complica tions. There is a clinical similarity between these IVIg-related encephalop athy and the "reversible posterior leukoencephalopathy syndrome", described by Hinchey et al., 1996.