Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autoimmune disorders. A study of four cases

Objective-To report on four patients with autoimmune disorders who develope d acute myocardial infarction (MI) during or soon after treatment with high dose intravenous immunoglobulins (IVIG) and to determine the clinical prof ile of patients prone to this complication. Methods-The clinical history of the four patients is reported with details concerning age, sex, indication for IVIG treatment, risk factors, timing of the MI and outcome. The relevant medical literature has been reviewed. Results-The patients, three men and one woman, aged 42-67, received IVIG tr eatment for different autoimmune disorders. All had a history of atheroscle rosis or previous risk factors such as hypertension, stroke, hyperlipidaemi a and obesity. Two of the patients suffered a MI after the first infusion o f IVIG while the others-after the 5th and 15th pulses. MI occurred during t he infusion in two patients and after a few days in the others. All the pat ients recovered from the acute event. These observations are in concert wit h sporadic cases of IVIG related thrombosis reported in the medical literat ure. Conclusion-In patients with vascular risk factors such as old age, hyperten sion, history of stroke or coronary artery disease, the possibility of IVIG related vascular complications should be considered and IVIG prescribed wi th a cautious re-weighted risk/benefit consideration.