Neutropenia Induced By Intravenous Immunoglobulin

Intravenous immunoglobulin (IVIg) is used as an immunomodulatory agent in various autoimmune disease and generally considered a safe therapy. Most of the adverse effects (AEs) associated with IVIg administration are mild and transient. The immediate (AEs) include headache, flushing, fever, and anaphylactic reactions, especially in IgA-deficient patients. Late AEs are rare and include acute renal failure, thromboembolic events, aseptic meningitis, and neutropenia. Patients with antibody deficiencies are more prone to develop acute netropenic episodes even during IVIg replacement. IVIG-induced neutropenia is transient and mild or moderate, and no severe infectious complications have been reported. We report a case of neutropenia in a patient with Guiilian-Barre syndrome (GBS) after infusion of IVIg.

A 57-year-old female presented with a 4-day history of quadriparesis. She had no previous medical history. She developed myalgia and progressive descending weakness involving both upper and lower extremities. Electrophysiologic study showed motor dominant neuropathy. There were no abnormal findings on brain magnetic resonance imaging. A raised protein concentration but a normal cell count was observed in cerebrospinal fluid (CSF). No virus-specific antibodies, bacteria, and fungi were detected in CSF, blood, and urine. She was administrated IVIg (0.4g/kg daily) for GBS. She gradually recovered strength in her extremities after 2 days. On day 3 administration of IVIg, severe neutropenia (absolute neutrophil count < 1500 cells/mm³) occurred. Tue infusion of IVIg was stopped, however, neutropenia lasted for 5 days. She developed a fever and was given granulocyte colony-stimulating factor. She improved and was discharged with no infectious and neurologic complications on the 15^th hospital day.

Acknowledgement

This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2015.