Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain-Barre syndrome

A pregnant woman developed acute demyelinating poly-neuropathy (Guillain-Ba rre syndrome (GBS)) in the 28th week of gestation (GW) after flu-like infec tion. Hypertension, liver dysfunction, and a decrease in consciousness leve l developed at 29 GW. Blood chemical analysis revealed increased levels of liver enzymes GOT 247 IU/I and GPT 624 IU/I. Viral serological study showed a positive test for Epstein-Barr virus IgM. Weakness of bilateral facial m uscles and limbs, a loss of tendon reflexes, and generalized paresthesia we re detected by neurologic examinations. Over the course of 5 days, a massiv e dose (100 g) of intravenous immunoglobulin (MIVIg) was infused in 30 GW. An average manual muscle testing score by the Medical Research Council meth od and peak flow value began to be significantly restored during and after MIVIg infusions. Values of the liver enzymes gradually decreased, and impro vement of the muscle weakness and dysbasia was observed. Her pregnancy norm ally ended in spontaneous vaginal delivery of a healthy infant in 37 GW. Th is is the first report confirming the efficacy of MIVIg, without plasmapher esis, in GBS-complicated pregnancy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.